AMBOSS, UWORLD, COMBANK - Questions With
Applicable Solutions
A 55-year-old man comes to the physician for evaluation prior to
parathyroidectomy. A Tc99m-sestamibi scan shows two spots of
increased uptake in the superior mediastinum. These spots
represent structures that are most likely derived from which of the
following embryological precursors? Correct Answer - 3rd
branchial pouch - pouches: ear (1), tonsils (2), bottom (3 - inferior
parathyroids) to (3- thymus) top (4 - superior parathyroids)
A 57-year-old man comes to the physician for a follow-up evaluation
of chronic, retrosternal chest pain. The pain is worse at night and
after heavy meals. He has taken oral pantoprazole for several
months without any relief of his symptoms. Upper endoscopy shows
ulcerations in the distal esophagus and a proximally dislocated Z-
line. A biopsy of the distal esophagus shows mature columnar
epithelium with goblet cells. Which of the following microscopic
findings underlies the same pathomechanism as the cellular changes
seen in this patient? Correct Answer - Squamous epithelium in
the bladder
A 22-year-old man comes to the emergency department because of
several episodes of blood in his urine and decreased urine output
for 5 days. His blood pressure is 158/94 mm Hg. Examination shows
bilateral lower extremity edema. Urinalysis shows 3+ protein and
red blood cell casts. Mass spectrometry analysis of the urinary
protein detects albumin, transferrin, and IgG. Which of the following
best describes this type of proteinuria? Correct Answer -
Nonselective glomerular
A 45-year-old woman with hypothyroidism comes to the physician
because of progressive fatigue, lethargy, and epigastric pain after
,eating. Physical examination shows pale conjunctivae. Laboratory
studies show decreased serum hemoglobin levels and increased
serum gastrin levels. Esophagogastroduodenoscopy shows
inflammation of the gastric body and fundus. A photomicrograph of
a biopsy specimen taken from the gastric antrum is shown (G cell
hyperplasia). Which of the following is the most likely cause of this
patient's symptoms? Correct Answer - Parietal cell destruction
Parietal cell destruction in the gastric fundus is seen in
autoimmune-mediated atrophic gastritis (AMAG), which results in
reduced gastric acid production. The reduced acid production in
AMAG leads to loss of negative feedback on G cells, which
subsequently causes G cell hyperplasia in the gastric antrum and
hypergastrinemia. Parietal cell destruction also impairs intrinsic
factor production and causes decreased vitamin B12 absorption in
the ileum, leading to vitamin B12 deficiency anemia (pernicious
anemia). However, iron deficiency anemia may be present earlier in
the disease course, due to the decreased solubility of iron in the
setting of hypochlorhydria.
A 66-year-old man comes to the emergency department because of
shortness of breath. His temperature is 37.2°C (99°F) and pulse is
105/min. When the blood pressure cuff is inflated to 140 mm Hg,
the patient's pulse is audible and regular. However, upon
inspiration, the pulse disappears and does not reappear until
expiration. Only when the blood pressure cuff is inflated to 125 mm
Hg is the pulse audible throughout the entire respiratory cycle.
Which of the following underlying conditions is most likely
responsible for this patient's physical examination findings?
Correct Answer - Asthma (pulsus paradoxus)
Pulsus paradoxus most commonly occurs in patients with
constrictive cardiac disease (e.g., cardiac tamponade, constrictive
pericarditis, tension pneumothorax) or severe obstructive lung
,disease (e.g., COPD, asthma). During inspiration, there is increased
systemic venous return and increased volume in the right heart,
which is compensated for by expansion into the pericardial space in
a healthy heart. However, in a pathologically constricted heart, this
increase in right ventricle volume causes bowing of the RV free wall
into the left ventricle, resulting in decreased LV filling, decreased
cardiac output, and subsequent drop in systolic blood pressure.
Pulsus paradoxus in patients with obstructive lung disease (e.g.,
asthma), on the other hand, occurs due to the amplification of
intrathoracic pressure variation during respiration, which is then
transmitted to the distal arteries.
A 51-year-old man comes to the emergency department because of a
3-day history of shortness of breath, fever, and chills. He has no
history of serious illness. His temperature is 39.5°C (103.1°F).
Physical examination shows a grade 4/6, holosystolic, blowing
murmur over the apex that radiates to the axilla. Crackles are heard
in both lower lung fields. Examination of the extremities shows
several nontender, nonblanching, erythematous macules on the
palms and soles. Histopathologic examination of these macules is
most likely to show which of the following? Correct Answer -
Microabscesses with neutrophil infiltration of capillaries
Microabscesses with neutrophil infiltration of capillaries and areas
of hemorrhage are characteristic of the Janeway lesions seen in
patients with infective endocarditis. They are thought to be caused
by septic microemboli from valve vegetations and, among other
vascular phenomena, constitute a minor clinical criterion for the
modified Duke criteria in infective endocarditis. Janeway lesions are
more common in acute endocarditis than in subacute endocarditis.
A 41-year-old female is brought into the emergency department by
paramedics after a motor vehicle accident. Upon arrival, she appears
to be stable but complains of mild abdominal pain. Osteopathic
, examination is notable for a nodule between rib 7 and rib 8 on the
right that is tender to palpation. CT scan of the abdomen reveals a
retroperitoneal hematoma. Trauma of which of the following
anatomic structures is most likely responsible for this finding?
Correct Answer - pancreas
key: not AA because she is relatively stable
A study is conducted by a Japanese research organization to
determine the role of cigarette smoking on the development of
chronic obstructive pulmonary disease (COPD) in Tokyo. Two
thousand patients with COPD are recruited for the experimental
group, and 3500 subjects without any respiratory disease are
enrolled for the control group. The mean values of age, BMI, blood
pressure, and blood levels of glucose and cholesterol are similar in
the groups. After enrollment into the study, the subjects are asked
whether or not they smoked at any point in their lives; for this
study, a history of smoking of at least one pack a year is considered
to be relevant to classify someone as a smoker. Which of these
statements most accurately describes this study? Correct Answer
- this is a retrospective study (do odds ratio, not relative risk)
A 72-year-old female lives in a rural town with only 1 family
practice physician. The next closest physician's office is 20 miles
away. She has not seen a physician in more than 10 years and is
concerned about her general health. Upon calling the office, she is
told that he is not currently accepting new patients and is unwilling
to see her. The patient becomes infuriated and threatens to sue the
physician. It is most accurate to state that the Correct Answer -
physician has no legal obligation to see or refer her (no patient
physician relationship established so no need to refer)
A 29-year-old female stockbroker presents to the emergency
department with palpitations and chest discomfort. She states that
Applicable Solutions
A 55-year-old man comes to the physician for evaluation prior to
parathyroidectomy. A Tc99m-sestamibi scan shows two spots of
increased uptake in the superior mediastinum. These spots
represent structures that are most likely derived from which of the
following embryological precursors? Correct Answer - 3rd
branchial pouch - pouches: ear (1), tonsils (2), bottom (3 - inferior
parathyroids) to (3- thymus) top (4 - superior parathyroids)
A 57-year-old man comes to the physician for a follow-up evaluation
of chronic, retrosternal chest pain. The pain is worse at night and
after heavy meals. He has taken oral pantoprazole for several
months without any relief of his symptoms. Upper endoscopy shows
ulcerations in the distal esophagus and a proximally dislocated Z-
line. A biopsy of the distal esophagus shows mature columnar
epithelium with goblet cells. Which of the following microscopic
findings underlies the same pathomechanism as the cellular changes
seen in this patient? Correct Answer - Squamous epithelium in
the bladder
A 22-year-old man comes to the emergency department because of
several episodes of blood in his urine and decreased urine output
for 5 days. His blood pressure is 158/94 mm Hg. Examination shows
bilateral lower extremity edema. Urinalysis shows 3+ protein and
red blood cell casts. Mass spectrometry analysis of the urinary
protein detects albumin, transferrin, and IgG. Which of the following
best describes this type of proteinuria? Correct Answer -
Nonselective glomerular
A 45-year-old woman with hypothyroidism comes to the physician
because of progressive fatigue, lethargy, and epigastric pain after
,eating. Physical examination shows pale conjunctivae. Laboratory
studies show decreased serum hemoglobin levels and increased
serum gastrin levels. Esophagogastroduodenoscopy shows
inflammation of the gastric body and fundus. A photomicrograph of
a biopsy specimen taken from the gastric antrum is shown (G cell
hyperplasia). Which of the following is the most likely cause of this
patient's symptoms? Correct Answer - Parietal cell destruction
Parietal cell destruction in the gastric fundus is seen in
autoimmune-mediated atrophic gastritis (AMAG), which results in
reduced gastric acid production. The reduced acid production in
AMAG leads to loss of negative feedback on G cells, which
subsequently causes G cell hyperplasia in the gastric antrum and
hypergastrinemia. Parietal cell destruction also impairs intrinsic
factor production and causes decreased vitamin B12 absorption in
the ileum, leading to vitamin B12 deficiency anemia (pernicious
anemia). However, iron deficiency anemia may be present earlier in
the disease course, due to the decreased solubility of iron in the
setting of hypochlorhydria.
A 66-year-old man comes to the emergency department because of
shortness of breath. His temperature is 37.2°C (99°F) and pulse is
105/min. When the blood pressure cuff is inflated to 140 mm Hg,
the patient's pulse is audible and regular. However, upon
inspiration, the pulse disappears and does not reappear until
expiration. Only when the blood pressure cuff is inflated to 125 mm
Hg is the pulse audible throughout the entire respiratory cycle.
Which of the following underlying conditions is most likely
responsible for this patient's physical examination findings?
Correct Answer - Asthma (pulsus paradoxus)
Pulsus paradoxus most commonly occurs in patients with
constrictive cardiac disease (e.g., cardiac tamponade, constrictive
pericarditis, tension pneumothorax) or severe obstructive lung
,disease (e.g., COPD, asthma). During inspiration, there is increased
systemic venous return and increased volume in the right heart,
which is compensated for by expansion into the pericardial space in
a healthy heart. However, in a pathologically constricted heart, this
increase in right ventricle volume causes bowing of the RV free wall
into the left ventricle, resulting in decreased LV filling, decreased
cardiac output, and subsequent drop in systolic blood pressure.
Pulsus paradoxus in patients with obstructive lung disease (e.g.,
asthma), on the other hand, occurs due to the amplification of
intrathoracic pressure variation during respiration, which is then
transmitted to the distal arteries.
A 51-year-old man comes to the emergency department because of a
3-day history of shortness of breath, fever, and chills. He has no
history of serious illness. His temperature is 39.5°C (103.1°F).
Physical examination shows a grade 4/6, holosystolic, blowing
murmur over the apex that radiates to the axilla. Crackles are heard
in both lower lung fields. Examination of the extremities shows
several nontender, nonblanching, erythematous macules on the
palms and soles. Histopathologic examination of these macules is
most likely to show which of the following? Correct Answer -
Microabscesses with neutrophil infiltration of capillaries
Microabscesses with neutrophil infiltration of capillaries and areas
of hemorrhage are characteristic of the Janeway lesions seen in
patients with infective endocarditis. They are thought to be caused
by septic microemboli from valve vegetations and, among other
vascular phenomena, constitute a minor clinical criterion for the
modified Duke criteria in infective endocarditis. Janeway lesions are
more common in acute endocarditis than in subacute endocarditis.
A 41-year-old female is brought into the emergency department by
paramedics after a motor vehicle accident. Upon arrival, she appears
to be stable but complains of mild abdominal pain. Osteopathic
, examination is notable for a nodule between rib 7 and rib 8 on the
right that is tender to palpation. CT scan of the abdomen reveals a
retroperitoneal hematoma. Trauma of which of the following
anatomic structures is most likely responsible for this finding?
Correct Answer - pancreas
key: not AA because she is relatively stable
A study is conducted by a Japanese research organization to
determine the role of cigarette smoking on the development of
chronic obstructive pulmonary disease (COPD) in Tokyo. Two
thousand patients with COPD are recruited for the experimental
group, and 3500 subjects without any respiratory disease are
enrolled for the control group. The mean values of age, BMI, blood
pressure, and blood levels of glucose and cholesterol are similar in
the groups. After enrollment into the study, the subjects are asked
whether or not they smoked at any point in their lives; for this
study, a history of smoking of at least one pack a year is considered
to be relevant to classify someone as a smoker. Which of these
statements most accurately describes this study? Correct Answer
- this is a retrospective study (do odds ratio, not relative risk)
A 72-year-old female lives in a rural town with only 1 family
practice physician. The next closest physician's office is 20 miles
away. She has not seen a physician in more than 10 years and is
concerned about her general health. Upon calling the office, she is
told that he is not currently accepting new patients and is unwilling
to see her. The patient becomes infuriated and threatens to sue the
physician. It is most accurate to state that the Correct Answer -
physician has no legal obligation to see or refer her (no patient
physician relationship established so no need to refer)
A 29-year-old female stockbroker presents to the emergency
department with palpitations and chest discomfort. She states that
