Vertigo And 37-year-old Woman

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26. A 31-year-old stockbroker drives to a high-altitude mountain resort to do some rock-climbing. Later that day, he experiences headache, fatigue, dizziness, and nausea. Which point on the graph above best corresponds to the relationship between plasma bicarbonate, pH, and Pco^ in this patient?

27. A 45-year-old woman presents with recent onset of blood-tinged discharge from the right nipple. The nipple appears slighdy retracted, and a ill-defined subareolar nodule can be appreciated on palpation. Mammographic examination reveals linear shadows attributable to calcification. An excisional biopsy is performed. Microscopically, the lesion consists of markedly dilated ducts that contain inspissated secretion and are surrounded by fibrosis and chronic inflammation. Focal calcium deposition is present. Which of the following is the most likely diagnosis?

(A) Abscess

(B) Adenocarcinoma

(C) Fat necrosis

(D) Fibrocystic changes

(E) Foreign body reaction

(F) Mammary duct ectasia

(G) Mondor disease

28. An adult who develops pure red cell aplasia should be explicitly evaluated for which of the following?

(A) Gastric adenocarcinoma

(B) Pancreatic adenocarcinoma

(C) Papillary thyroid cancer

(D) Seminoma

(E) Thymoma

29. Which of the following is the most common type of lung cancer in nonsmokers?

(A) Bronchioloalveolar carcinoma

(B) Bronchogenic adenocarcinoma

(C) Large cell anaplastic carcinoma

(D) Small cell (oat cell) carcinoma

(E) Squamous cell carcinoma

30. The 10-year-old daughter of a United Nations ambassador in Turkey develops a severe sore throat, which resolves after a few days. Ten days later, the mother notices dark stains on the child's underwear and takes her to the pediatrician. A urine sample appears smoky, and red cell casts are noted in the urinary sediment. If a renal biopsy were obtained from this chdd it would probably show

(A) dense deposits

(B) fusion of podocyte foot processes

(C) linear deposition of IgG

(D) mesangial IgA deposits

(E) subepithelial humps

31. A 37-year-old woman presents to her physician complaining of difficulty reading and fatigue. She reports having had a "pins and needles" feeling in her left arm several months ago that resolved without treatment. On examination, visual field deficits and mild hyperreflex-ia are noted. MRI confirms the suspected diagnosis. Which of the following is the underlying mechanism of this patient's disease?

(A) Antibodies to acetylcholine receptors

(B) Axonal degeneration

(C) Demyelination of the peripheral nerves

(D) Loss of oligodendrocytes

(E) Loss of Schwann cells

32. A blood sample from a patient with polycythemia vera is sent for complete blood count. Which of the following blood components is most likely to be reported within normal limits?

(A) Lymphocytes

(B) Neutrophils

(C) Platelets

(D) Red blood cells

(E) White blood cells

33. A 60-year-old man suddenly becomes completely blind in one eye, and angiography demonstrates occlusion of the central retinal artery. Which of the following is the most likely cause of the occlusion?

(A) Atheroma or embolism

(B) Cranial (temporal) arteritis

(C) Hypertension

(D) Polycythemia vera

34. A 55-year-old man with a history of recurrent calcium-containing renal stones presents to the emergency department with excruciating flank pain and blood in the urine. This patient is likely to have which of the following underlying disorders?

(A) Anemia of chronic disease

(B) Chronic Proteus infection

(C) Factor VIII deficiency

(D) Hyperaldosteronism

(E) Hyperparathyroidism

35. A 26-year-old woman accidentally inhales a peanut while laughing hysterically at a comedy club. Her friends bring her to a nearby emergency department, where it is revealed that the peanut lodged in her right mainstem bronchus. Which of the following is true about the blood flowing through the area of lung distal to the peanut?

(A) The amount of dissolved oxygen is greater than normal

(B) The oxygen dissociation curve is left-shifted

(C) The Pco is lower than normal

(D) The pH is lower than normal

(E) The PQ approaches that of arterial blood

36. A 40-year-old man who recently immigrated from Japan presents to his physician with abdominal discomfort characterized by sensations of fullness and mild pain after eating. He was previously diagnosed with a gastric ulcer, which has been refractory to traditional treatment. Biopsy of the lesion reveals gastric carcinoma. The cancer is most likely located in which of the following regions of the stomach?

(A) Antropyloric region

(B) Apex of the cardia

(C) Greater curvature of the body

(D) Lesser curvature of the body

(E) Within 6 cm of the gastroesophageal junction

37. The earliest evidence that a myocardial infarction has occurred consists of

(A) infiltration of the myocardium with leukocytes

(B) intercellular edema with "wavy change" of affected myocytes

(C) necrosis with preservation of cell oudines

(D) proliferation of fibroblasts

(E) a softened, yellow plaque on the endocardial surface

38. A 65-year-old woman with an 8-year history of type 2 diabetes dies in the hospital. She had no other significant medical history. Which of the following was the most likely cause of death?

(A) Diabetic ketoacidosis

(B) Infection

(C) Myocardial infarction

(D) Renal failure

(E) Stroke

39. A 21-year-old woman attempts suicide by taking an overdose of barbiturates. On arrival in the emergency department, her blood pressure is 95/65 mm Hg, and her pulse is 105/min. The physician in the intensive care unit orders arterial blood gases. Which of the following values would you expect in this patient?

40. An accident in a dry cleaning facility exposes an employee to massive amounts of carbon tetrachloride, both on the skin and by inhalation. Severe damage to which of the following organs is most likely to occur?

(B) Intestine

(C) Kidney

(E) Stomach

41. A 65-year-old man complains of weakness, weight loss, and bone pain. He reports having progressive difficulty seeing. Physical examination is significant for hep-atosplenomegaly and lymphadenopathy. Serum protein electrophoresis reveals an M-protein spike, with an elevated serum IgM level. Bone marrow aspiration shows intensely eosinophilic plasma cells. Urine contains Bence-Jones proteins. Which of the following is the most likely diagnosis?

(A) Heavy chain disease

(B) Monoclonal gammopathy of undetermined significance

(C) Multiple myeloma

(D) Plasmacytoma

(E) Waldenstrom macroglobulinemia

42. A patient has a lymphoproliferative disorder containing mature B cells that mark weakly with kappa light chain on the plasma membrane, strongly with CDS, strongly with CD23, and weakly with CD22. Which of the following is the most likely diagnosis?

(A) Chronic lymphocytic leukemia

(B) Hairy cell leukemia

(C) Non-Hodgkin lymphoma

(D) Pro lymphocytic leukemia

(E) Sezary syndrome

43. The EKG of a 60-year-old man reveals QRS intervals of 0.14 seconds with distincdy abnormal configurations. Physical exam is significant for paradoxical splitting of the second heart sound. Which of the following conduction defects is likely in this patient?

(A) Complete AV block

(B) First-degree AV block

(C) Mobitz Type 1 AV block

(D) Mobitz Type II AV block

(E) Wo Iff-Par kin son-White syndrome

44. A 56-year-old man presents with complaints of gnawing pain in the mid-epigastrium, with occasional radiation to the back. He also notes a 15-pound weight loss over the past 3 months. The clinician suspects pancreatic carcinoma. Which of the following tumor markers would aid in confirming this diagnosis?

(A) Alpha-fetoprotein (AFP)

(C) Carcinoembryonic antigen (CEA)

(D) Human chorionic gonadotropin (hCG)

(E) Prostate-specific antigen (PSA)

45. A 19-year-old man is brought into the emergency department with a gunshot wound to his leg. He is pale and tachypneic, his blood pressure is 90/65 mm Hg, and his pulse is weak and rapid at 130/min. This man's condition corresponds to which point (A-E) on the above graph?

46. A 25-year-old drug abuser with history of gonorrhea presents with fever and shortness of breath. Pulse oximetry reveals hypoxia. A chest x-ray film is significant for bilateral interstitial infiltrates. Which of the following findings is consistent with the most likely diagnosis?

(A) Acid-fast organisms in sputum

(B) Appearance of Curschmann spirals in mucus plugs

(C) Elevated serum cold agglutinins

(D) Posidve methenamine-silver stain of lung tissue

(E) Presence of Charcot-Leyden crystals in sputum

47. A 46-year-old woman who is clearly jaundiced is seen in clinic. Laboratory tests reveal conjugated hyperbilirubinemia. Urine bilirubin levels are significantly above normal, while urine urobilinogen levels are significantly below normal. Which of the following mechanisms is the most likely cause of her jaundice?

(A) Blockage of the common bile duct

(B) Deficiency of glucuronyl transferase

(C) Hemolytic anemia

(D) Hepatocellular damage

48. A 35-year-old woman complains of vomiting dark, greenish material approximately 1 hour after eating. She is scheduled for a barium meal to evaluate the upper portion of the gastrointestinal tract. She denies pain and is anicteric. Which of the following is the most likely cause of this woman's condition?

(A) Annular pancreas

(B) Esophageal atresia

(C) Gallstones

(D) Meckel's diverticulum

(E) Pyloric stenosis

49. Accumulation of which of the following substances indicates aging at a cellular level?

(A) Beta-carotene

(B) Bilirubin

(C) Hemosiderin

(D) Lipofuscin

(E) Melanin

50. A 57-year-old man presents with painless swelling in his neck. Physical examination is remarkable for splenomegaly. Biopsy of the neck mass reveals a neoplasm containing small, cleaved cells that recapitulate the normal follicular architecture of lymph nodes. Which of the following mechanisms is most likely involved in the development of this padent's neoplasm?

(A) Amplification of L-myc

(B) Homozygous loss of p53

(C) Over-expression of bcl-2

(D) Point mutation in ras decreasing its GTPase activity

(E) Reciprocal translocation between chromosome 9 and 22

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