1.Block 1 Part 1 1. 70yo M dies in a motor vehicle collision. Was undergoing evaluation for occult blood in the stool. Photo of transverse colon shown. Dx? - Tubular adenoma 2. 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? - Loratadine 3. 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? - IgM?? 4. 24yo M with small tender blisters on his penis 3 days after unprotected sex. Photograph shown. Causal agent? - Herpes simplex virus type 2 5. 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? - Rosacea 6. 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? - Malaria 7. 68yo F with T2DM and hypertension that has eben 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? - Lisinopril 8. 66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after receiving chemotherapy with flourouracil, leucovorin, and irinotecan. perscribed opioid antidiarrheal agent with no CNS effects. Which med? - Loperamide 9. 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, commashaped bacteria; no erythrocytes of leukocytes. MOA of toxin? - Activation of adenylyl cyclase 10. 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? - Cerebellum 11. 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? - Congenital cytomegalovirus infection Ten minutes later. No/No (150).15 to 40 13. Each assigned by coin toss to one of tw groups. and the compound is not concentrated in the cell. Female newborn is delivered at 38 weeks' gestation. ECG shows normal sinus rhythm. BP 105/60. Has ischemic heart disease. PE shows edematous. What is quantity of drug (in mg) injected? . Newborn has male genital ducts but female external genitalia. PE normal. and food. Epidemiologic study of aniline dye.Carrier-mediated diffusion 21. Design? . BMI 32. Friend reports that the patient injected himself with a drug 6 hours ago. Odds ratio? -3 19.Scrotum 22. Bony outgrowth of vertebrae compressing one of the spinal nerves is suspected. 70yo M from china with poorly differentiated monoclonal carcinoma of the nasopharynx.3. he has tried diet and exercise.Contemplation 16. 64yo M in ED 3 hours after SOB with exertion and extreme fatigue. and genetic testing shows a mutation of the gene encoding 5alpha-reductase. has a half-life of 2 hours. Physician recommends initiation of insulin injections. But a lot of people in my family have diabetes. Exposed to aniline dyes/Have Bladder cancer: Yes/Yes (250). 38yo M with 3-year hx of T2DM.T lymphocytes 17. In absence of this mutation. Which describes this mechanism of transport? .480 20.Candomized clinical trial . labia majora would have been? . No energy is necessary for uptake. "I know that insulin would help control my blood sugar. fluod0filled mass approximately 5 cm in diameter in the midline over the lumbosacral region. PE shows a bulging. Labs show drug concentration of 0. Abnormality most likely occurred because of abnormal development during which periods of postconception (in days)? . P 125/min. Apgar 8 and 8 at 1/5 min. 24yo M with 2-day history of an itchy rash on his arms and legs. Patient is at which stage of change? . and insulin made them really sick at times. knee. Cause is activation of which cell types? . Study designed to evaluate the efficacy of coenzyme Q10 in improving cardiac output in patients with CHF. DNA probes of neoplastic cells are most likely to detect genome of which virus? . 500 workers with bladder cancer and 200 workers without. 24yo M with hx of IVDA could not be aroused.Torsades de pointes 14.Epstein-Barr virus 18. Risk for which drug effect in the next 6 hours? . No/Yes (250).XY karyotype. Yes/No (50). Hb A1c is 10%.12. Cytogenetic analysis shows a 46. Compound is taken up by bacterial cells. Nerve root in which intervertebral foramina is effected? . Assuming first-order onecompartment kinetics. Intravenous ibutilide is administered. 65yo F with 20-year hx of osteoarthritis of the hands now has pain radiating down the distal anterior thigh. Returned from a camping trip in the woods 5 days ago. Taking an oral antihyperglycemic agent. No spontaneous movements of the lower extremities. medial leg.L-3 to 4 15. and a volume of distribution of 200 L in this patient. Sixty patients with CHF are recruited. Responds. erythematous rash with linear vesicles. ECG shows atrial fibrillation. 50yo M with increasing cough for 6 month and hemoptysis for 1 week."It must be difficult for you to accept this diagnosis when you feel healthy. "Do you think that my weight gain is inherited from my father?" Appropriate response? . Separation of the umbilical cord was delayed after birth. Tells patient he has lung cancer. Atrial Natriuretic Peptide INCREASED?? 24. Type of error? .Disruption of normal splicing by creation of a new 3' splice site?? 32. with exons in bold. BMI is 32. CXr shows diffuse interstitial infiltrate. T 38C." #3orthopod."Yes. HIV viral load <50. Sequence surrounding the first two exons of the human beta-globin gene shown. Ten subjects from both the control and treatment groups do not complete the study are are not included in the analysis. CXR shows a 3 x 4-cm hilar mass. CD4 22. Cytologic examination of sputum shows a non-small cell carcinoma. Diagnosis? . Treatment group able to fall asleep 5 minutes faster than control (p=0. worse in morning and improve during the day. Lungs clear. Pretest probability for TA is 50% in this patient.001). Conclude that new med is efficacious in treating insomnia.X-rays of the sacroiliac joints 28. Smoked 1 pack per day for 32 years. Mechanisms impaired? . PE shows extreme muscle wasting. 52yo M neighbors have reported that he has been confused and not taking care of himself. stomatitis. swims. Physiological changes? . 18mo girl. SOB.Additional testing to confirm the diagnosis of TA 31. No pus formation at infection sites. Jan 28. carinii). and a diffuse rash that is worse in sun-exposed areas. "How can this be happening to m? I eat right and exercise. and nonproductive cough. HIV ELISA positive. Translation start codon is underlined. Neither group report an improvement in quality of life. most appropriate next step? . A mutation from G-->A at position 355 is most likely to lead to beta-thalassemmia by which mechanism? .Failure to distinguish between statistical significance and clinical significance 25. Back stiffness if he sits for prolonged periods.23. Plays squash. 12yo boy immersed up to his neck in 60F water for 20 minutes. In the evaluation of TA. Immigrated to USA from the Ivory Coast 4 years ago. ESR has a sensitivity of 99% and specificity of 60%. ADH (vasopressin) INCREASED. your weight gain can be caused by genes and environment combined. Has had four severe skin infections Staphylococcus aureus.Pellagra 30." Appropriate resposne? . The patient reponds. High dose prednisone and trimethoprim-sulfamethoxazole is initiated. the pain radiates to his buttocks but not down his legs. 4mo Hx of diarrhea.Central blood volume DECREASED. 32yo M with 6-month hx of low back pain and stiffness. 80yo F with suspected temporal arteritis (TA). 2016 Block 1 Part 2 26. Based on the restults of the ESR testing. Silver stain obtained via bronchoscopy shows Pneumocystis jiroveci (formerly P. No medical illness. 42yo M in ED because of a 10-day history of progressive fever. HIV western blot positive. Which to confirm diagnosis? . Rndomized controlled study of 2000 patients with insomnia is conducted to evaluate the efficacy of a new medication to treat this condition." 29. and workup for HIV infection is done.Leukocyte adhesion and transmigration 27. Persristent leukocytosis in absence of infection. ESR is 100. Explanation? . 20-kg weight loss. 17yo boy with 8-kg weight gain during the past year. He asks. Photomicrograph shown.Interleukin-8 (IL-8) 42. 27yo F with vaginal bleeding for 3 weeks.Kidney 38. malaise. failure. endomyocardial biopsy specimen shows myofiber necrosis with a mixed inflammatory infiltrate of PMNs. Tumor derived from? . 40yo F with mole on her back that has increased in size during past 4 months. MRI shows calcified cystic mass in suprasellar region. Pregnancy test neg. 28yo F G1P1 with 2-day history of a painful mass in her right breast. Which factor accounts for recruitment of PMNS to inflammatory site by intestinal epithelial cells? . 27yo F with fever. Given ventilatory support with up to 80% oxygen for the next 72 hours. but dies of resp. 30yo F training for a marathon. in addition to liver.006. and vaginal d/c for 4 days. bilateral lower quadrant tenderness with rebound and guarding. Causal org? . Cause is inadequate secretion from which labeled cell types? . hyperchromatic cells within clear islands that tend to collapse. U/A shows specific gravity less than 1. Dx? . PE shows enlarged uterus.. Labs show GH deficiency. LMP 5 days ago.Staphylococcus aureus 41. Male newborn at 28 weeks'. First pregnancy ended with a spontaneous abortion 8 months ago. beta-hCG markedly increased. which organ. No Rx since dilatation and curettage at that time. edema of lower ext. Causal org? . PE normal. PE shows raised irregular lesion with variegated black-tan pigmentation and ill-defiined margins.Actinic keratosis 37.Trophoblastic tissue 34. 20M with 3-month hx of progressive thirst (drinking a lot of fluids) and urinary frequency during past 3 days. PE shows 3-cm tender mass surrounded by an area of erythema beneath the right areola.D?? Not sure about this one. CT scan shows a necrotic intrauterine mass and metastatic nodules in the lungs. 3yo boy with bacterial colitis caused by Salmonella enterica serovar arizonae. 39. running 20 mild/day.Diverticulum of the roof of the embryonic oral cavity 40.Trypanosoma cruzi 35. and been breast0-feeding since. releases glucose? . 42yo farmer has a 7-mm red scaly plaque on helical rim of left ear. T 37C.Gonorrhea 43. Visual field testing shows bitemporal hemianoia. Site of Origin? . Pleomorphic. Looking for surfactant. Ultrasonagraphy of pelvis shows material within the endometrial cavity and no intrauterine pregnancy. 9yo girl with poor growth during the past year.Melanoma 36. and eosinophils. abdominal pain. T lymphos. T 38. Fasting glucose is 60. 65yo M emigrated from Brazil with 8-month history of shortness of breath and fatigue.Infection with HIV-2 33. Dx? . Delivered healthy female newborn 3 weeks ago. m.Posterior pituitary gland . < 3rd %ile for height and at 10th percentile for weight. Dx? . Pelvic exam with cervical motion tenderness and bilateral adnexal tenderness WBC 18k.3 C. Had ectopic 1 year ago. CXR shows cardiomegaly. After her glucose stores have been depleted.phages. Extend from epidermis into papillary dermis. Most likely has dysfunction of which endocrine structure? . K+ 6. Pulse 90. and theophylline bedside. blue tinged rounded mass at anal margin. Labs: Na+ 130. 50yo man has persistent cough for 2 months.Dissecting aneurysm 48.Omeprazole 2. 21yo M in ED with excruciating anal pain for 4 hours. HCO3 5.Epinephrine 3. 2016 Block 2 Part 1 1. Exam shows 15-mm.Insertion of transvenous pacemaker 50.1. pCO2 25 mm Hg. PE normal. BUN 55. Stool shows: Fecal fat negative. respirations are 6/min. Jan 28. Dx? . T 38. 3-year hx of cocaine abuse. 37yo M with 4-day hx of diarrhea and abdominal pain. Physician's face makes patient cry and ask. atenolol. Cx for infx negative. Cause? . Physician sad to inform patient of progression of carcinoma to the terminal phase. Next step? . Cr 5. Medications: hydrochlorothiazide. bp 90/60. C. 1-week-old girl. 2/6 diastolic murmur at left sternal border. Mechanism of renal failure? . pH 7. PE shows no tongue biting. Thin." 4. Crackles heard over all lung fields.Naloxone #4orthopod. Completed a 10-day course of amoxicillin for a sinus infection 5 days ago. Found bottles of albuterol. worse in past 24h. 20yo man with 6-hour difficulty breathing and vomiting. Lungs clear. P 100/min. Represents thrombus in a tributary of which blood vessel? .5. BP 150/45. but dizzy. "It's bad news. He has had a 5 kg (11 lb) weight loss. with watery-brown stools.Pseudomemnbranes of fibrin and inflammatory debris 47. Ultrasound shows bilateral hydronephrosis and dilated ureter. BP 92/56. 55yo M with chronic bronchitis in ED after being unresponsive. enalapril. Diff toxin positive. codeine. Physical shows dehydration. isn't it?" Which is best response? .2.2 C. 10-year history of type 1 diabetes on insulin. omeprazole. Variable intensity S1. glucose 500. 79yoM 30 minutes after LOC for 30 seconds. screening showed a possible defect in fatty acid oxidation. No urinary or fecal incontinence. Next step? . p 112/min. ECG shows a third-degree atrioventricular block. CXr shows a widened aortic arch. Alert. 75yo man 2-year history of decreased force of urinary stream. 50 %ile for length and weight. Which compound stimulated hormonesensitive lipase in adipocytes causing accumulation of metabolites causing acidosis? . it is. Oriented X3. Which pathologic findings present in intestinal tract? . Acute Rx should include? . Physical exam otherwise normal. ampicillin. PE: diminished pulses in left upper extremity. 28yo M in ED 30 minutes after SOB.Immature lower esophageal sphincter 46. ova and parasites negative. He is a farmer and on itraconazole 4 weeks for histoplasmosis from chicken coops.44.Inferior rectal vein 45."Yes.Measurement of serum acylcarnitine concentrations 49. Pulse 40/min. 6-week-old girl with 6-day hx of vomiting small amount of milk 2 to 3 times daily. urinate several times throughout night. BP 95/60. and metoclopramide for hypertension and gastroesophageal reflux.0. respirations 30 and deep. T 37. Itraconazole interacts with which drug and account for lack of effect of itraconazole? . 45yo man poorly controlled type 2 diabetes 1-month low-grade fever. Pelvic exam: adnexae are nonpalpable. Which is best initial response? .Congenital ureteral obstruction 6." 13. Urinalysis pH 8. Xray chest reticulonodular pulmonary infiltrates consistent with interstitial fibrosis. 65yo woman surgical repair of aneurysm right internal carotid artery in cavernous sinus. Diagram of . Bilateral basilar crepitant crackles. BMI 27. Genetic analysis shows homozygous cytochrome P450 2D6*4 alleles. Physical subclavian catheter below right clavicle. Physical exam normal.Endometrial hyperplasia 15. many RBCs. 60yo man progressive shortness of breath past 3 months.Increased hydrostatic pressure in Bowman space 5. 50th percentile height and weight. Radiologic studies show dilation of left ureter and renal pelvis. Endometrial curettage shows abundant tissue. Bleeding during menses and at irregular intervals. Blood cultures grow nonhemolytic. Cardiac exam no murmurs. 4yo boy two bacterial urinary tract infections past year. 43yo woman for health maintenance exam. Calculi composed of? . 3yo boy sickle cell disease with fever and pain over left foot 3 weeks. physical exam right pupil larger than left pupil. T 37 C (98. Photo: dilated renal pelvis and ureter.2 F). Which organism? . Weakness of eye movement. Likelihood patient's sisters has same alleles? . gram-positive cocci in pairs and chains.Struvite 14. Abdominal xrays bilateral staghorn renal calculi. Which is most likely explanation for findings? . 48yo nulligravid woman with excessive uterine bleeding for 3 months. Hematocrit stable. Worked in shipyard. No menstrual period. when enters.Breast bud development 9. Left nephrectomy done.25% 10. active metabolite of prodrug tamoxifen. WBC. Physical exam absence of breast bud development and no pubic or axillary hair. Physician 30 minutes late for appointment because of emergency.Tracheoesophageal atresia 12. pulse 72. Leukocyte count 15."I'm sorry I got delayed. History of recurrent urinary tract infections.Enterococcus faecalis 7. I hope I haven't made you late somewhere else. Temperature is 39 C (102.and progesteronepositive invasive ductal carcinoma of breast. Getting hemodialysis for end-stage renal disease. 50yo sister also hormone-sensitive breast cancer.Alveolar macrophage 11. patients checks watch. Menses were regular before. minimal left-sided renal function. Which is cause of renal disease? .Osteomyelitis 8. bp 144/92. It is most appropriate to tell mother that first objective sign of puberty will be which? .6 F). Lungs clear. Physical exam tenderness of right flank. 30yo woman 20 weeks gestation.000 predominance of neutrophils. 45yo woman follow-up exam after 8 weeks tamoxifen therapy for estrogen.. 10yo girl well-child examination. Which abnormality is cause? . Respirations 25. Three days later. bacteria. Ultrasound shows increased amniotic fluid. catalasenegative. Physical exam normal. Which is cause of symptoms? . Fundal height is greater than expected for gestational age. 27yo woman 12-hour history of fever and abdominal pain. uncomplicated pregnancy. Picture: sputum sample of elongate structures (ferruginous body). Fibrosis initiated by interaction of structures with which cell? . Serum decreased concentrations of endoxifen. Taking estrogen replacement therapy for postmenopausal symptoms. Which nerve is damaged? -A 16. irritability. Physical exam: erythema nasal mucosa. cannot focus. Ten human subjects given new oral drug to monitor drug effect and toxicity. and generalized joint pain. wakes up during night. This degradation beings when p53 protein targeted to which type of cell enzymes? . 80yo man type 2 diabetes 2-month history severe constipation. No psychosis. Which are clinical consequences of ALL patients homozygous for low-activity alleles of TPMT? . Diffuse spasticity in arms and legs. This protein promotes cell growth and malignancy by causing cellular p53 protein degradation. Xray patchy bilateral opacicites. Taking lorazepam for 15y for generalized anxiety disorder. Lungs scattered crackles.Ubiquitin ligase 25. Vital signs normal. 55yo woman 6-week history low energy. Physical exam normal. absence of muscle stretch reflexes in ankles. thiopurine methyltransferase (TPMT). Failed antibiotics.Phase 1 22. Which changes to autonomic nervous system occurred? . decongestants and nasal corticosteroids. Cause of symptoms? . Pulse 130 bp 80/60.Use of sunscreen by her peers 23. two small ulceration. Which cellular components most likely to have deficient function in tuberculous lesions in lungs? . Labs: Hemoglobin 13. maternal grandfather died of metastatic melanoma. parasympathetic efferent activity decreased 20. Efficacy and toxicity of 6-MP correlated with 6-TGN. bilateral extensor plantar responses.Macrophages 24. 6-MP acted on by xanthine oxidase (XO). Which vitamin is deficient? . Laxatives haven't relieved symptoms. Mental status shows constricted affect. Patient has dysfunction of which nerve? . Abdominal exam shows distention. 34yo AIDS patient with pulmonary tuberculosis. ESR . leading to inactive metabolites. 6-MP acted on by enzymes to make 6-thioguanine nucleotides (6-TGN). crying spells.Sympathetic efferent activity increased." Speech is slowed. Wishes she wouldn't wake up but doesn't plan to harm herself. 60yo man difficulty walking. 6-Mercaptopurine (6-MP) used to treat acute lymphoblastic leukemia (ALL). difficulty falling asleep. In patient this age.Major depressive disorder 17. 34yo man lightheaded after running 12 miles of marathon hot day.coronal section through middle cranial fossa shown. Colonoscopy shows no abnormalities. impaired proprioception in his feet. 44yo woman follow-up after two Pap smears showing atypical squamous cells of undetermined significant. Test shows viral E6 protein of human papillomavirus.They may be given normal doses of 6-MP (?) 21. Mother dx squamous cell carcinoma face. Ten years after total gastrectomy. 40yo woman hx of 6 month episodic sinusitis with 2-week intermittent headaches. Mood is "testy. 15yo girl health maintenance exam. increased muscle stretch reflexes in arms and knees. Which trial type? . fatigue. which factor most predicts compliance with photoprotection? . Blood analyzed for human pharmacokinetics of drug for first time. No CD4+ T lymphocytes in peripheral blood.Pelvic splanchnic 19.B12 (cobalamin) 18. worsening cough productive of blood-tinged sputum. Rheumatoid arthritis 27. 35yo woman abnormal Pap smear. Physical shows cyanosis. Physical: mild epigastic tenderness.Incomplete formation of pleuroperitoneal membrane 29. bp 140/85.First-degree burn 32. Temp 37 C (98. 2-day hx of fever. fatigue. If operation required to control bleeding.Wegener granulomatosis Administrator #5orthopod. Cervical biopsy shows microinvasive cervical carcinoma. Thrombocytopenia most likely caused by a drug with which of the following mechanism of action? . 81yo woman massive pulmonary embolism from deep venous thrombosis. One week later.Salicylate poisoning 31. 22yo woman. Which embryological event led to these findings? . ABG pH 7.42 pCO2 30 pO2 95 HCO3 19.000. Xray shows nasogastric tube in left hemithorax. Exam: atrophy of labia minora and thin. 50yo woman 1-year hx of hot flashes and irregular menses. parchment-like skin over vulva and anus. Dx? . severe vaginal bleeding.000. Small nodules palpated beneath skin around joints of fingers. Temp 38. mediastinum displacement to right. Physical exam: severe erythema of back and extremities. platelets 55. nausea.Internal iliac 35. Dx? . miconazole for yeast infections ineffective. Endotracheal and NG tubes placed. Mechanism of drug? . Physical exam: bilateral swelling of proximal interphalangeal joints. Apgar 3 and 5 at 1 and 5 minutes. 2016 Block 2 Part 2 26. Alendronate prescribed.1 C (100. Dx? .6 F).Inhibition of osteoclast-mediated bone resorption 28.6 F). heavy vaginal bleeding. 2016 Last edited by a moderator: Feb 10.The junction of the superior vena cava and the right atrium 33. and wrists.500. absence bowel gas in abdomen. Pelvic exam: open cervix. 25yo woman 6-month history of joint pain poorly responsive to aspirin. g1p1. No medications. Which area should be avoided to leave sinoatrial (pacemaker) node intact? .70. Dx? . ligation of branch of which artery required? . pulse 100. weakness of grasp.Lichen sclerosus 30. 58yo man supraventricular tachyarrhythmia refractory to pharmacotherapy gets ablation of accessory excitatory pathway in atrial endocardium. Female newborn at 36 weeks gestation has respiratory distress. Platelet count 160. antineutrophil cytoplasmic antibody increased. respirations 24.Neoplastic cells in sub-basement membrane connective tissue . 75yo man 2-day ear ringing. She used sunblock. Dx? .Potentiates the action of antithrombin III 34. Which microscopic features led to dx? . 65yo women progressive vulvar itching past 2 months. Jan 28. Appropriate pharmacotherapy is started. US shows uterus with no placental tissue or thrombi. metacarpophalangeal joints. no blisters. four days ago delivered healthy male newborn. 15yo girl 1-day hx redness and painful skin following sunbathing. Decreased bone mineral density. leukocyte 10. School performance declined. clumsy. Temperature 36. 56yo woman with restrictive cardiomyopathy. hepatosplenomegaly. Biopsy shows acid-fast bacilli.36. mild depression of left zygomatic bone. respirations 20. places. forgetting names. weakness and muscle tenderness. Which physical finding is likely? . Physical exam: circumcised penis. Physical exam: edematous tissues of left eye. soft small tests 5 mL. bp 110/60. Physical exam shows hypopigmented.Inhaled glue 43. "Has not been himself" for months. malaise. proteinuria. BMI 23. Physical bilateral crackles lower lobes. Twelve hours after procedure. Nerve damaged causing sensory loss? . CT chest bilateral hilar adenopathy.Myoglobin 37. Increased in which in serum? . Best explanation why the organism results in dermal rather than visceral infections? . Sleeps better upright. parotid enlargement. Urinalysis 3+ protein. Patient's condition is from increased release of which substance? .4 F). Structure of material? . Lab findings? . Congo red statin: birefringent pattern under polarized light. She binges on high-carbohydrate foods 2 to 3 times a week. 15yo girl emigrated from India and with several lesions on neck for 2 weeks. Testosterone low.beta-pleated sheet structure 45. respirations 20. Physical exam: erythema nodosum. Skin between eye and upper lip numb. Cause of edema? . 40yo African American woman 2-week hx fever. dates. renal failure. bp 150/90.25-Dihydroxycholecalciferol 44. Temperature 38 C (100. Calcium 16. Drug for immediate relief of acute symptoms? . has paresthesias of hands and feet.Maxillary division of trigeminal nerve . 14yo boy come to ER 1 hour after colliding with teammate playing soccer. 35-year history of rheumatoid arthritis. carpal spasm on inflamation of bp cuff. Slow to answer questions. HR 90. Creatinine 4. Double vision look upward. 16yo boy with no signs of puberty.1. 14yo boy daily headaches for 2 months. 41yo man with asthma and allergy to grass pollen wheezes and difficulty breathing 10 min after mowing lawn. 17yo girl 1-day shortness of breath. Sex development Tanner stage 2. nontender. Headaches are bilateral aching in temples. 63yo man 3-month hx difficulty sleeping. Which hormone is cause of decreased serum testosterone and lack of pituitary hormone stimulus? . dyspnea.Increased capillary hydrostatic pressure 46. mild ankle edema.7 C (98 F). Confused. Vitals stable.Parotid gland enlargement 39.Luteinizing hormone 38.Temperature sensitivity 40. 28yo woman wants to lose weight. Physical exam: increased jugular venous pressure. frequent falls. prostate firm. forcing herself to vomit after. Chronic abuse of which substance? . Physical exam: broad-based ataxic gait.Decreased parathyroid hormone. 59yo man has total thyroidectomy for 4-cm follicular carcinoma of thyroid. decreased calcium 41. hypoesthetic area on left side of forehead and 4-cm lesions on neck.Albuterol 42. Did triathlon previous day. muscle tenderness. no discharge or lesions. BMI 19. 4+ hemoglobin. Renal biopsy shows glomerular deposition of eosinophilic hyaline material. loss of proprioception. but mother with two younger brothers with same sx and maternal uncle who died at 8 of mild head trauma. blocking protein synthesis intracellularly. also takes glipizide. Labs show Hb 7.Nephrolithiasis 5. Both parents healthy. impulsive and difficult over past year. jerking.Schistocytes 4.Vitamin E 2. bulky stools for 4 years and two episodes of bacterial pneumonia and chronic cough since age 1 year.4 F). Treatment with antibiotics and prednisone over next 3 weeks recovers. HCT 24%. 34yo woman with pyelonephritis treated with bactericidal antibiotic 4 days no improvement. Antibiotic added that inhibits binding to 30S ribosome. Increased risk of which complications of underlying process causing joint findings? . Everything's been normal. 35yo man increasingly depressed. Has primary . 4-year Hx of increasing serum creatinine concentrations. BP 150/100.Gentamicin 50. photomicrograph of it is shown. pulse 98. Cr 1. 6yo boy from Russia with unstable gait and incoordination for 2 weeks. 3yo boy and his 5yo brother with recurrent hemarthroses. Grimaces intermittently with rapid. respirations 18. 54yo F 1 week after sudden loss of vision in left eye. 27yo primigravid woman at 34 weeks' with nausea and vomiting. AST 112. and abdominal pain for 12 hours. ALT 126. P 120/min.2.47. 18yo man Crohn disease 1-day hx severe abdominal pain and intermittent bloody diarrhea.T-lymphocyte function 49.Answer is NOT E . Chest X-rays normal. Began furosemide 1 month ago. Defect? . 3-month hx of progressive SOB with exertion. 56yo F follow-up 8 weeks after recovering from pneumococcal pneumonia. total bili 2. Which describes the lesion? .Myxoma 3. 2016 Block 3 Part 1 1. Echocardiography shows mass in the left atrium of the heart. purposeless movements of fingers. Platelets 72k. Stool shows inc fat concentration.3. Joint fluid shows negatively birefringent crystals. Partial thromboplastin time is prolonged.4. Peripheral blood smear will show? . Which allowed this resolution to occur? . Mechanism of pharmacotherapy is suppression of which? . Historical factor relevant in dx? . returned within 1 day.Answer might be D. 60yo F 3 hours after sudden onset ankle pain. 3%ile for height/weight.Factor VIII (antihemophilic factor) Administrator #6orthopod. Neuro exam shows ataxia. Physical exam: draining anal fisutla. and right upper quadrant tenderness. Metaplasia of mesenchymal cells to pneumocytes? 6. Temperature 38 C (100. Jan 28. BP is now 164/102. Vitamin deficient? . no DTRs. Lesion is resected.Family history of a similar illness 48. Antibiotic? . 29yo F with 5-week hx of fatigue and 4-day hx of heart palpitations and anxiety. Pale. resp 25/min. Hemogrlobin concentration is 9.hypothyroidism Rx with triiodothyronine.Vasodilating prostaglandins at the afferent arteriole 12. "We can't bear to be apart. Peripheral blood smear is shown. It would be cruel to separate us now. 54yo F with hypertension and bilateral renal artery stenosis starts taking NSAIDS for back pain.2. Free triiodothyronine INCREASED 7. platelets 350k. Her Cr concentration increases from 1. TFT will show which? . BP 85/50. gamma-glutamyltransferase 25 (n = 030). Effect: estradiol production 14. and wheezing. Most appropriate diuretic. 72yo M with weakness and fatigue. uncle. Drug with which mechanism is appropriate? . 20yo F has multiple neurofibromas. Cause of hypotension? . chronic cough.Admit the patient to the hospital for possible myocardial ischemia 11.".Tissue: Testicle. Liver biopsy will show? .0 to 5. No family. Infection ruled out." at all her visits and now she is moved to inpatient hospice after she decides she wants no further curative therapy. PCWP low. 50yo M smoked 2 packs per day for 34 years. Which Lab abnormalities is expected? . Free thyroxine DECREASED. Most appropriate next step? . scattered rhonchi. Says. AST 110. systemic vascular resistance low. Drinks eight to ten 12-ounce cans of beers daily for 10 days. Liver is tender. Most likely binding site of hCG causing gynecomastia? . Pulmonary artery catheter shows: Cardiac output high. Cause is due to inhibiting which? . P 110/min. with 2-hour Hx of substernal chest pain. 8yo boy with disruptive behavior. Mom.Spironolactone 17. No meds. P 100/min. Serum: total bili 5.Gastrointestinal blood loss 18. 83yo M brought to ED after being found at home bedridden and confused. with SOB on exertion. Photo shown of throat. trouble completing tasks. 45yo M with yellow skin. 65yo F with widely metastatic breast cancer unresponsive to chemo. Receiving thyroid hormone and steroid replacements since removal of pituitary adenoma 2 years ago. Mode of inheritance? .Increased urinary excretion of HCO3? 10.Mallory hyaline 9. always moving. is which? . Which response is appropriate? . BP 160/100. WBC 5400.9.TSH DECREASED. 35yo M uses crack cocaine daily.Increased release of dopamine and norepinephrine 16. Cause? .0. 38yo F with 3-day hx of sore throat. 32yo M with 3-month hx of swelling and breast tenderness.Vagus 15. 62yo M with alcohol-induced liver disease develops ascites. ALT 69. "close friend. diminished breath sounds. in addition to loops. BP unchanged after 1L IV saline. Began hCG injections 4 months ago. Alk Phos 210.Autosomal dominant 8." elevating area at tip of the arrow? .Early septic shock 13. T 37C. but she has doubled the dose because of fatigue. and brothers with similar lesions. Which nerves is tested by saying "ah. interrupts. Increased AP diameter. Dynein arms 23. 32yo F G2P1 at 7 weeks' gestation with vaginal bleeding for 3 days and increasingly severe left abdominal pain for 18 hours. checks lock 3-4 times a night. pseudostratified epithelium with small patches of squamous metaplasia and mild lymphoid infiltration. Dx? . Cervical os is closed. Fetahl heart sounds are heard. ciliated. Menses have been irregular for the past 6 months. Jan 28.Calcium #7orthopod. Cause of coma is bleeding from which structures? . and muscle aches. WBC 12K. PE shows uterus consistent with 22-week gestation. Which is related to pathogenesis? . and feet. 30yo primi at 22 weeks' gestation with 1-day hx of fever.Inhibition of phophodiesterase 22. Worried about people braking into her house."The two of you seem to have a very important relationship. serum beta-hCG is 6000. Cardiac examination shows PMI at fourth intercostal space within the midclavicular line on the right. BP 104/72. chills. 42yo M with multiple lesions over his body. Endoscopy shows nasal polyps. Causal organism? . Comatose. 2016 Block 3 Part 2 26.Hereditary spherocytosis . 35yo M with recurrent sinusitis and bronchitis.Sertraline 29. Hepatic margin is palpable on the left. Of course you may stay together. U/S shows empty uterus. Biopsy shows extensive epidermal acantholysis resulting in the formation of intraepidermal blister. 30yo M in ED 15 minutes after found unconscious. 52yo F with hot flashes.Suppressing the early response of T lymphocytes to activation 20. 68yo M with 6-month hx of erectile dysfunction." 19.. Not breast feeding.Failure of the ovaries to secrete 17beta-estradiol 27. involuntary contraction of muscles. CT head shown. Splenectomy is indicated if anemia is caused by which? . P 114/min. Intact basal layer of keratinocytes adherent to basement membrane is identified. Cyclosporine decreases likelihood of rejected by which actions? . 1-month hx of frequent episodes of pins-and-needles sensation around the mouth. Physiologic cause? . 50yo M 3 days after his first generalized tonic-clonic seizure. Worries constantly that the infant is ill and wakes up to make sure he is well. PE and labs normal. Rx? . 46yo M treated with oral cyclosporine after cardiac transplant. drug with which MOA? .Ectopic pregnancy 28. T 39. 26yo F 5 weeks after birth of first child. PE shows flaccid bullous erosions involving upper and lower extremities and torso. Blood cultures grow gram-positive rods. diffuse hyperreflexia. Spleen is five times normal.Development of autoantibodies against desmosomal proteins 25. hands. not reactive to light.Listeria monocytogenes 24. Which structure most likely to be absent on electron microscopic exam of epithelium? . resp 15/min. Direct and rebound tenderness with guarding in left lower quadrant.Middle meningeal artery 21. pupils 4 mm in diameter. Which serum electrolyte is abnormal? . Washes her hands 30 times per day.4. Biopsy shows thickened. 10yo boy has had anemia since birth. If pharmacotherapy is indicated. Neuro exam shows mild. Explaination? . Dx? . 55yo M with sepsis. BP 160/100.8. and marked muscle rigidity. and decreased metalloproteinases.15% 38.Fibromuscular dysplasia 35. Low-cholesterol diet and exercise program ineffective after 1 year. iron INCREASED. Sigmoidoscopy and rectal biopsy show IBD. T 39.0. spider angiomata. 41yo F with increasingly severe headaches for 6 weeks. ALT INCREASED. Agitated.Tumor necrosis factor 34. but unable to tolerate greater than 20 mg daily.Strangulation 39. Additional finding? . transferrrin sat INCREASED. MOA of drug that should be administered? . T 38. nurses note she has torn up four breakfast menus because she is confused. Lovastatin initiated. 57yo M with alcoholism has distended abdomen with shifting dullness. Protein found in brown adipose tissue of mice causes leak of H ions inward across inner mitochondrial membrane. and painful urination. Which drug? . Labs show WBC 14k. Monoclonal antibody is begun. tachycardia. While lifting weights.Decreases release of Ca from the sarcoplasmic reticulum 37.Delirium 31. P 132/min. 48yo M with bronzing of his skin.Gynecomastia . and small testes.8C. 45 with asthma are detected. weakness. No aedema. PE shows warm. Admitted to hospital. BP 85/48. Operation is terminated when patient develops hyperthermia. Dx? . Rx with vancomycin and ceftriaxone initiated in ED. 24yo M swelling in right inguinal region. fluid wave. Cause? . Prevalence? . increased collagen and fibronectin. 60yo F with 3-year Hx of hyperlipidemia. 62yo F in ED for 2-day hx of fever. Appears anxious and confused. Serum: AST INCREASED. testosterone DECREASED. 24yo with second-degre burn.Increased ratio of oxygen consumption to ATP generation 41.30. Effect of this protein on oxidative phosphorylation and energy metabolism? .Ezetimibe 32. PE shows hepatomegaly. flushed skin. FSH DECREASED. 45yo M with intermittent bloody diarrhea and abd pain. caput medusae. In a survey of 100 households (average three residents per household).Increased intestinal iron absorption 33. Photograph shown of small intestine resected. tissue shows increased fibroblast migration and proliferatoin. bruit over left costovertebral angle. Administrer which solutions? . Additional drug is added that inhibits transport of cholesterol through intestinal wall. ferritin INCREASED. which is directed against what components? . 36yo M undergoes elective liposuction under general anesthesia. abdominal tenderness. U/A norma. Caused by production of which? . palmar erythema. Angiogram of left renal artery shows alternating areas of stenosis and aneurysmal dilatation ("string of beads" sign).Transorming growth factor-beta 40. LH DECREASED. and fatigue during the past 3 months. Two weeks after.9% Saline 36. cardiac valve defect and concentric LVH. ALT 60. Autopsy. Appears confused. 62yo M dies suddenly while playing tennis. 16yo girl with 2-year hx of fainting. Alk Phos 200.Imprinting 49. 67yo M has urinary urgency after placement of urinary bladder catheter during transurethral resection of the prostate. Labs show Hb 14. IgG anti Hep A positive. Platelets 50K. PE shows ascites and ankle edema.42. This is because periumbilical region and appendix are both supplied by afferent fibers in dorsal root ganglia of which levels? .Aflatoxin 45.5. No alcohol. and bleeding from venipuncture sites. Anti hep B negative. Deficiency of which? .Aortic stenosis 47. increased in frequency during past 6 months. chills. Symptoms due to systematic release of which cytokines? . Plasma shows undetectable noreipinephrine and marked increase in dopamine concentration when standing. When both pronuclei are paternal. Scratched his arm on a nail yesterday. Peanut farmer in china. Cr 2. 60yo M from china to USA with 1-month hx of confusion and swelling of abdomen and legs. BP 110/80 supine and 60/40 standing. no meds. Neuro exam normal. No cardiac risk factors. 25% lymphos). ecchymoses. 20yo M with suspected appendicitis has periumbilical burning and discomfort. Which lab finding? .Calcified 80% stenosis Administrator #8orthopod. 42yo M in ED for 5-hour hx of fever. Which genetic mechnanisms? .?? 44. produces have poorly developed embryonic tissue. total bili 2. T 40C. When the pronuclei are maternal. Liver palpable. Mild HTN. 18-yo F with sepsis after an abortion. Within 24 hours she becomes dyspneic. U/S shows 10 cm lesion. Jan 28. HCt 42%. Biopsy shows dysplastic hepatocytes in small clusters and rows with no normal architecture. 63yo M with 6-month hx of exertional chest pain relieved by rest. produces have poorly developed extraembryonic structures. anti hep C negative. Exposure to which? . Serum: Albumin 4. and severe pain and swelling of his left arm.Dopamine beta-hydroxylase 43. Which valve abrnomalities is most likely involved? .Decreased plasma fibrinogen concentration 50. Smoked 1 pack per day for 40 years. Most appropriate Rx has which MOA? . Mouse embryos are produced with two pronuclei. spleen isn't.Inhibition of muscarinic receptors 48. Cyclophosphamide affects which target? .IL-1 and tumor necrosis factor (TNF)-alpha 46. 2016 Block 4 Part 1 1. localizes to RLQ 5 cm superomedial to anterosuperior ilica spine. oliguric. BP 71/38. WBC 15K (35% PMNs.8. 40% bands. Serum BUN 28. smoked for 45 years. both of same parental origin. no hx of CAD. and develops petechiae. AST 45. 65yo F with ovarian cancer treated with cyclophosphamide and other chemotherapeutic agents. Which lesion in LAD is most likely cause? . 60yo M 1-month Hx of progressive SOB with exertion. mechanically ventilated with fungemia with Candida albicans. 38yo M in ED 30 min after unable to stand upright. Breath sounds: Dec on right lung base.21-hydroxylase 9. HCO3 11 ABG: pH 7. and bloody diarrhea 2 hours ago. Deficiency of ? . Which chemical mediator? . nml on left lung base Tactile fremitus decreased on right lung base.Left atrium 8. C-cell hyperplasia. K 3. Cl 101.Metabolic acidosis 11. normal on left lung base Percussion note dull on right lung base. nml on left lung base Adventitious sounds none on right lung base. Cause? . nausea. 60yo M in ED for sudden onset of acute abdominal pain and tenderness. 56yo M 4 hours after sudden onset of uncontrollable irregular movements of the left side of the body. BP 90/62.2. 45yo F intubated. Midepigastric tenderness. Which vaccine given? .28.Pleural effusion 7. signals brain about stored fat.Right subthalamic 6.Calcitonin 4. Hx of dilated cardiomyopathy. Pelvic exam shows clitoromegaly and a normalappearing uterus. Pco2 23. Rx with caspofungin is started. X-rays of esophagus w/ barium contrast show indentation and posterior displacement of the esophagus. and suppresses appetite by its action in the CNS. He has a Hx of cirrhosis and hepatocellular carcinoma. 2mo boy given vaccine to convert T-independent antigens to T-dependent forms to enhance protection in young children. Nuclei damaged? . Pharm co trying to develop a long-acting weight-loss agent that mimics activity of a naturally occurring peptide originates in adipose tissue. PE shows increased hair growth on the face and chest. Menarche was at age of 14 years. Which marker to monitor? . BP 116/62. malignant. Po2 98 Acid-base status in this patient? . pulse 110/min. Bilateral thyroid lesions with spindle cells arranged in small clusters. Amyloid deposits b/w neoplastic cells. Labs show: Serum: Na 143. Surgery shows small intestine with dark purple-red hemorrhagic appearance. 25yo F with 3-year hx of irregular menses. vomiting. BP 99/50. Serum shows increased 17-hydroxyprogesterone and androstenedione. PE shows dry mucosa and poor skin turgor. crackles on left lung base Dx? . 68yo M with difficulty swallowing solids for 2 months.Mesenteric venous thrombosis 10.. Feature of causal organism targeted by this drug? . Enlargement of what caused dysphagia? . Lethargic. Underwent adrenalectomy for pheochromocytoma 3 years ago.Leptin 3.Beta-Glucan carbohydrates in the cell wall 5. 45yo F has thyroidectomy because of asymmetric enlargement of thyroid noticed 6 weeks ago. PE shows flailing movements of the proximal appendicular muscles on the left. Loss of bowel sounds.DNA replication 2. " "Lost my pep. Resp 28/min."using something twice daily can be difficult. standing .Information. Lesion? -G (Does anyone know what part of the brain this corresponds to?) 18. Surgeon gives info of risks and benefits. Which is injured? . PE shows firm. Male newborn has macrocephaly with poor skull mineralization. 69yo F with weakness of left leg since awakening." Hx of poorly controlled hypertension. 6yo girl with 4-day hx of round shiny bumps in areas where she has eczema. PE shows weakness. PE shows diaphoresis.2. ECG normal. smooth. Which drug? .Placebo effect 13. In this patient. and 3. to be used in specified sequence twice daily. patient is most likely carrier of? . Just started medication 2 weeks ago.Levator labii superioris 22. Coronary angiography shows occlusion of marginal branch of LAD coronary artery. I assume you are like most patients who miss at least 10% of treatments. Explanation? . In a clinical study. and decreased position sense in the toes." 20.0. shortened extremities with misshaped long bones.Haemophilus influenzae type b 12. finger feeding. Decreased somatic sensation in left foot. and several fx.Collagen 21. Fifty patients randomly assigned . 2. No other Sx.3 15. A study conducted to assess effectiveness of injections of lidocaine into "trigger points" of pain symptoms in patients with fibromyalgia. CK-MB and troponin I increased. Defect in which? .9% saline only or saline plus lidocaine. 27yo F in ED 30 min after ejected through windshield during MVC. Patient says that he understands what he has been told. is found to be tightly linked to the gene for polycystic kidney disease.Protease inactivation by cytplasmic free calcium ions ?? NOT SURE ABOUT THIS ONE 14. Babinski present on left. Mechanism of these lab findings? . How to begin discussion of compliance? . PE shws marked edema and tenderness of the jaw. BP 130/85.Poxvirus 16. 58yo F in ED for 2-hour hx of SOB and chest pain radiates to her back between the shoulder blades. Pedigree shown. Serum potassium is 3. which combination of components fulfill the criteria for fully informed consent? . Girl for well-child exam. Unrestrained front-seat passenger. agraphesthesia on plantar surfaces of the toes. 47yo F with psoriasis for follow-up. 68yo M in for a hemiorrhaphy. a polymorphic marker with three alleles. Was given several topical creams. Normal development includes pincer grasp. competence. Causal organism? . umbilicated papules 2 to 4 mm diameter in clusters. If III. Pe normal. MRI shows edematous area in cerebral cortex of right hemisphere. 1 is unaffected by this disease. Graph shows self-reported pain scores. Revascularization done with stent placement. 1. No improvements apparent at this appointment. Her mother saw similar bumps on a playmate at pool party 3 weeks ago. Panorex x-ray of mouth shown. voluntariness 19.Hydrochlorothiazide 17. and his family will be able to discuss later.. 80yo F in ED for 2-day hx of "feeling funny. Exam shows collection of foamy histiocytes within the dermis. muscle pain. CD8 10%. 48yo F with 2-month hx of fatigue and intermittent headaches. Bitten by a tick a few days ago. Dx with laceration of the spleen and undergoes splenectomy. 35yo M with 4-day Hx of high-grade fever. 2016 Block 4 Part 2 26. CBC and CXR normal. HCT 42%. Kappa 47%. Temp 39.while holding onto a table. CT abdomen shows tumor . Labs show increased serum total thyroxine (T4) concentration.Absence of functional LDL receptors in hepatocytes 25. lambda 3% Which is most predictive of a clonal lymphoid proliferation? . 28yo F at 18 weeks' gestation has palpitations. PE shows diffuse abdominal tenderness. Predisposed to infection with? . lethargy. Serum show a decreased potassium concentration and increased aldosterone. lymphos 50%. Rx? . Study of breast cancer in women. Arterial Po2 DOWN.Doxycycline 30.Cohort 31.Thyroid antibodies 27. 70yo F in longitudinal study of effects of aging on pulmonary function tests. Best test to confirm hyperthyroidism? . 45yo F farmer in ED for 2-day hx of confusion. Organism? . Warfarin begun. Age (in months)? -9 23. Hundred healthy women observed for 10 years. PE normal. wife and kids had similar illness. 21yo M in ED 45 minutes after sustaining multiple injuries in a MVC. 18yo M with yellow nodules on achilles tendons of his feet and extensor tendons of his hands. Serum cholesterol is 980. platelets 250k Flow cytometry analysis of peripheral lymphocytes shows: CD3 50%. Monos 5%). BP 180/110. fever.Streptococcus pneumoniae 28. Best design? . PE normal. and lipoprotein electrophoresis shows a selective increase in LDL. T 38. 60yo M exam prior to employment. His BP is 90/50. Alveolar-arterial Po2 difference UP 29. Labs show PT of 12 seconds. vomiting.Influenza virus 30 rofhalpcervicalbumAdministrator #9orthopod. headache. 62yo F with recurrent pulmonary emboli comes for follow-up. Labs show Hb 14.5 C. and a rash on her wrists and ankles.2. Causal virus replicates its genome within the cell's nucleus.VII (proconvertin) 32. malaise. Which clotting factors is first to be decreased by 50% after initiation of Rx? . loss of appetite. PE normal.Residual volume UP. Which represents woman now compared with results at age of 20 years? . sever muscle aches. CD4 40%. Underlying disorder? . and playing peekaboo. PE normal. and a nonproductive cough. Red-purple papules on distal extremities progress to trunk. Goal is to determine if number of family members who previously received dx of breast cancer correlates with incidence of future development of cancer. WBC 12k (PMN 45%.Surface kappa:surface lambda ratio 24. Jan 28. DTR strongest in which locations? . Which neoplasm? . Doesn't feel depressed.Total hemolytic complement concentration 35. VSS. Which lab test is most likely abnormal? . Increase of which liver function? . Neuro exam shows right eye does not adduct past the midline on horizontal gaze when looking to the left.on adrenal gland. fracture of right mid humerus with severing of the radial nerve. holosystolic murmur heard best over left fifth intercostal space adjacent to the sternum. Mass is palpable in LUQ of abdomen. Shrugs in response to congratulations about his new job. 30yo F has ptosis. Which % are between 400 and 600? . 55yo F with left flank pain and gross hematuria.Renal cell adenocarcinoma 37. Ultrasonography shows a 12-cm solid mass on lower pole of left kidney. 20yo F with 1-day hx of increasing urinary frequency and a burning sensation with urination. 19yo M in MVC. 42yo F with 1-mo Hx of abdominal pain.Mannose-binding (type 1) fibria 34. and a fracture of right tibia. ophthalmoplegia.Thymoma 42. 6yo boy with 3 systemic infections with Neisseria meningitidis over the past 2 years. intermittent diarrhea. 13yo girl 2/6. and diplopia. Lesion is where? -C 38. BMI 18. When convergence is tested. BMI 31. Urine shows rare epithelial cells and 10 WBC/hpf. Healthy otherwise. and rectal bleeding with passage of mucus. PE shows jaundice and tenderness of RUQ.Decreased plasma renin activity 33. This bacterial strain has which virulence factors? . Which additional findings supports aldosterone-secreting adrenal adenoma? .Left Achilles tendon 39.67% 43. Exam scaled so scores are normally distributed with mean of 500 and SD of 100. no hobbies. Angiograms show hypervascular mass. after eating fatty meals. 40yo F with 1-year hx of episodes of crampy abdominal pain. PE shows mild suprapubic tenderness to deep palpation. the right eye is able to adduct past the midline. 28yo F with 3-week hx of double vision. Initial Rx? . 27yo M for employment exam.Schizoid 41. Rightward horizontal gaze is normal. Episode of blurry vision in left eye that improved during next 2 months w/o Rx. coli > 100k. 62yo M with pericardial friction rub 3 days after acute myocardial infarction. Personality disorder? . One sexual partner. Sigmoidoscopy shows diffuse ulcers. Urine grows E.Sulfasalazine 40. uses condoms. Minimal contact with parents and siblings. After 10 weeks. Flat affect. it increases with inspiration. Abnormality of which valves? . Dx? . No Hx of major illness. Never been sexually active.Tricuspid 36. Abdomal exam: diffuse tenderness with no rebound. Cause of rub? . Penetrating wound to right cerebral cortex with paralysis of the left lower extremity. Serum shows autoantibody with affinity for acetylcholine receptor at the postsynaptic neuromuscular junction.Fibrinous pericarditis 44. 45). Plasma osmolality 250. Cause is absence of? . RCT to compare wound healing and cosmetic differences between two surgical procedures for closing skin after C section. Diagnosed with disorder caused by increased synthesis of compounds in the skin that are subject to excitation by visible light. 40yo M with interstitial pulmonary fibrosis has greater maximal expiratory flow rate than predicted.Cholesterol synthesis 45. Cl 85.Increased radial traction on airways (You must log in or sign up to post here. not dehydrates. Four years ago. Platelets 165k. No drugs.Neither procedure is superior 50. 60yo M with 6-month hx of fatigue. Labs show: Hb 8. Urine osmolality 750. Drinks 6-8 beers daily.Proliferative endometrial tissue?? NOT SURE ABOUT THIS ONE 47. had subtotal gastrectomy after gunshot wound. B12 10 (N = 160-195). Surgical specialists cannot be blinded to the procedure. Dx? .Parietal cells 49. HCT 24%. Which best explains this? . Which accurately represents comparison bewtween A and B? . unable to conceive another child. 70yo M with recent loss of mental function. Cr 15. WBC 5k. which causes formation of vessicles and blisters on the skin which take weeks to heal. PE shows paresthesias of both hands. Bx of cyst will show? . MCV 115. One 6yo daughter. Results show procedure A has a lower rate of wound infection compared with B (relative risk 0. RBC Folic acid 500 (N = 125-600). 38yo F with 2-year hx of pain and heavy flow with menses causes her to miss work. BUN 15. 40yo M skin extremely sensitive to sunlight.Pulmonary neoplasm 46. Which biochemical pathway is defective? .) .Heme synthesis 48. PE shows mildly enlarged left ovary and retroflexed uterus. U/S shows substantial evidence of ovarian cysts and one peritoneal cyst.. VSS. Hx of weight loss.3 1. K 4.66.4. 95% CI 0. Labs show Na 110. Mild anemia. Ibuprofen not effective.