A) Amyotrophic lateral sclerosis
B) Cervical spondylosis
C) Multiple sclerosis
D) Myasthenia gravis
E) Myasthenic (Lambert-Eaton) syndrome
F) Myotonic muscular dystrophy
G) Polymyalgia rheumatica
I) Progressive neuropathic (peroneal) muscular atrophy
not acute interstitial nephritis you idiot.
nausea, and imbalance. He has a 20-year history of poorly controlled hypertension. His
pulse is 70/min, respirations are 20/min, and blood pressure is 210/115 mm Hg.
Examination shows a small right pupil, mild right ptosis, and nystagmus. Neurologic
examination shows weakness of the right palate. Sensation to pinprick is decreased over
the right side of the face and left extremities. There is incoordination on finger-nose
testing and heel-knee-shin testing on the right. Which of the following arteries is most
likely to be occluded?
A) Anterior spinal
G) Left vertebral
H) Posterior spinal
C) Left anterior cerebral
I) Right anterior cerebral
D) Left internal carotid
J) Right internal carotid
E) Left middle cerebral
K) Right middle cerebral
F) Left posterior cerebral
L) Right vertebral
A) Internal small-bowel herniation
B) Intestinal ischemia from a cardiac embolus
C) Intramural hematoma of the proximal small bowel
D) Intussusception of the small bowel
E) Malrotation of the small bowel
is the correct answer ,
It is a case of warfarin toxicity which resulted in hematoma formation , the patient has clear signs of bowel obstruction .
The negative Ob in the stool and significant drop in Hb can’t be explained by any other answer .
a)High pulmonic vascular resistance
b) high systemic vascular resistance
c) low pulmonary vascular resistance
d) low systemic vascular resistance
e) patent ductus arteriosus (wrong)
was at the age of 14 years. Menses occur at irregular 35- to 50-day inten/als and last 10 days; they are not painful. Menstrual ﬂow is normal. She has no history of serious illness
and takes no medications. She used an oral contraceptive for 16 years for menstrual cycle regulation but discontinued it 2 years ago. Her husband’s sperm count is within the
reference range. The patient is 152 cm (5 ft) tall and weighs 72 kg (160 lb); BMI is 31 kg/mi’. Physical examination shows acne vulgaris over the face, upper shoulders, and back.
The remainder of the examination, including pelvic examination, shows no abnormalities. Serum thyroid-stimulating hormone, free testosterone, dehydroepiandrosterone sulfate
(DHEAS), luteinizing hormone, and follicle-stimulating hormone concentrations are within the reference ranges. Which of the following is the most likely diagnosis?
) Bisphosphonate therapy
) Calcitonin therapy
) Calcium therapy
) Dexamethasone therapy
) 5% Dextrose in 0.225% saline therapy
) 5% Dextrose in 0.45% saline therapy
) 5% Dextrose in water therapy
) Fluid restriction
) Hydrocortisone therapy
) Lactated Ringer’s solution
) Mannitol therapy
) Potassium therapy
) 0.9% Saline therapy
) 3% Saline therapy
) Sodium bicarbonate therapy
A 6-month-old girl is brought to the physician because of poor feeding and labored breathing for 2 months. She has had recurrent respiratory tract infections since birth. Examination shows a to-and-fro murmur in the second left intercostal space, a loud S2, bounding peripheral pulses, and a widened pulse pressure. Which of the following is the most likely diagnosis?
A) Atrial septal defect (ostium primum type)
B) Atrial septal defect (ostium secundum type)
C) Atrioventricular canal
D) Coarctation of the aorta
E) Hypoplastic left heart syndrome
F) Patent ductus arteriosus
G) Tetralogy of Fallot
H) Transposition of the great arteries
I) Tricuspid atresia
J) Ventricular septal defect
More common in girls (2:1), babies where maternal rubella infection was present, and premature infants. Typically asymptomatic; patients with large defects may present with FTT failure to thrive, recurrent lower respiratory tract infections, lower extremity clubbing, and CHF. Wide pulse pressure, bounding arterial pulses, and characteristic sound of “machinery” (to-and-fro murmur)
Indomethacin-induced closure helpful in premature infants. Term infants often require surgical closure.
A newborn is in severe respiratory distress immediately following delivery. She was born at 35 weeks’ gestation to a 35-year-old woman, gravida 2, para 1, aborta 1, who did not receive prenatal care. The newborn’s pulse is 60/min, and respirations are irregular and labored. Examination shows pallor with perioral cyanosis, anasarca, hepatosplenomegaly, and scattered petechiae. Cord blood hemoglobin is 4 g/dL, and reticulocyte count is 18%. A direct antiglobulin (Coombs’) test is positive. Which of the following sets of blood groups is most likely in the mother and her newborn?
A) A, Rh-positive O, Rh-positive
B) A, Rh-positive O, Rh-negative
C) A, Rh-negative O, Rh-negative
D) O, Rh-positive O, Rh-negative
E) O, Rh-negative O, Rh-positive
A) Step 2 American Heart Association cardiac diet
B) Serum lipid studies while fasting
C) Exercise stress test
D) Oral cholestyramine and niacin therapy
E) Oral pravastatin therapy at bedtime
Femoral Popliteal dorsis pedis posterior tibial
Right 3+ 2+ 0 0
Left 3+ 2+ 2+ 2+
The right ankle brachial index is 0.6 (N>1), and the right answer is daily exercise programleft is 0.9. In addition to smoking cessation, which of the following is the most appropiate next step in management?
1- daily exercise program
4. Femoropopliteal bypass grafting
) Erythrocyte casts
) Hyaline casts
Head circumference (cm)
Which of the following is the most likely cause of increased intracranial pressure?
A) Acute cerebral edema
B) Decreased absorption of cerebrospinal fluid
C) Dilation of cerebral arteries
D) Intracranial mass lesion
E) Obstruction of lateral sinus
F) Obstruction of superior vena cava
G) Obstruction of cerebrospinal fluid flow
H) Overproduction of cerebrospinal fluid
) Leukocyte casts
) Oxalate crystals
Mean corpuscular volume 70 μm3
Urea nitrogen (BUN) 17 mg/dL
Glucose 90 mg/dL
Creatinine 2 mg/dL
Uric acid 14 mg/dL
Which of the following is the most appropriate next step in management?
A) Measurement of blood lead level
B) Measurement of serum porphobilinogen level
C) CT scan of the abdomen
D) MRI of the brain
E) Carbidopa-levodopa therapy
and what also i though is that chronic alcoholism can lead to B6 def –> block of heme pathway –> anemia. so measuring serum porphobilinogen level is also a possible ans ?
given that pt had abd pain & headache, much more goes with lead rather than b6 def
glucogon is reduced it is starvation….insulin raised but Resistance.
glucogonoma unlikely (no diarrhea and it is very rare so not my first pick unless specific like necrolytic migratory erythema..
bicarbonate reduced since it is acidosis
HDL cholesterol no effect
Ketones are not high because in type 2
A ) Detrusor instability
B ) Interstitial cystitis
C ) Overflow incontinence
D ) Stress incontinence
E ) Urethra diverticulum
F ) Urinary fistula
1. A 70-year-old woman has had increasing abdominal pain over the past 2 days. She has renal failure and has been receiving peritoneal dialysis for 18 months; her last treatment was 2 hours ago. She appears toxic. Her temperature is 39 C (102.2 F), and blood pressure is 140/90 mm Hg. Her abdomen is distended and diffusely tender to deep palpation with rebound tenderness. Leukocyte count is 18,000/mm3. Which of the following is the most appropriate next step?
A ) X-ray films of the abdomen
B ) Comparison of abdominal fluid amylase with serum amylase activity
C ) Gram’s stain of abdominal fluid
D ) Ultrasonography of the abdomen
E ) CT scan of the abdomen and pelvis
30. One month after undergoing an uneventful renal transplant for chronic renal failure secondary to glomerulonephritis, a 38-year-old woman is hospitalized because of increased serum urea nitrogen (BUN) and creatinine levels. Prior to transplantation, she had been receiving hemodialysis for 3 years. Current medications include cyclosporine and prednisone. Examination shows no abnormalities. Over the past 48 hours, urine output has remained stable. Both renal biopsy and a radionuclide scan confirm the diagnosis of acute rejection. Which of the following is the most effective treatment?
A) Immediate discontinuation of cyclosporine
B) Increased dosage of corticosteroids
C) Diuresis and alkalinization of the urine
D) Renal dialysis for 1â€”2 weeks
E) Transplant nephrectomy
20. A 72-year-old man comes to the physician because of a 7-month history of leg weakness and dry eyes and mouth. He also has had a 10.4-kg (23-lb) weight loss over the past 4 months despite no change in appetite. He has smoked one and a half packs of cigarettes daily for 50 years. He drinks 4 oz of alcohol daily. He has peptic ulcer disease and emphysema. Medications include cimetidine, theophylline, and low-dose prednisone. Examination shows mild ptosis. He has a barrel-shaped chest. Breath sounds are distant. There is moderate weakness of the proximal muscles of the lower extremities. Reflexes are absent. He has difficulty rising from a chair. Sensory examination shows no abnormalities. An x-ray film shows a hyperinflated chest and a 3 x 4-cm mass in the right hilum. His neurologic findings are most likely due to a lesion involving which of the following?
A) Muscle membrane
B) Parasympathetic nervous system
C) Peripheral nerve
D) Presynaptic neuromuscular junction
E) Sympathetic nervous system
22. A 3-year-old girl is brought to the physician after her mother noted blood on her underpants. Examination shows genital condylomata acuminata in the perineal, peri-introital, labial, and anal areas. Some of the pedunculated condylomata appear to have caused the bleeding. She has no visible intravaginal condylomata or vaginal or anal tears. Her mother has a palmar wart on her hand but no history of condylomata acuminata. Her mother has a boyfriend who does not live with them and who has never been left alone with the girl. They live with the mother’s 27-year-old brother who only baby-sits the children when they are asleep. Which of the following is the most appropriate next step in management?
A) Psychiatric assessment of the mother
B) DNA typing of the mother’s palmar wart for papillomavirus
C) Treatment of the mother’s palmar wart
D) Vaginal, anal, and throat cultures for Chlamydia trachomatis and Neisseria gonorrhoeae in the child
E) Laser therapy of the condylomata acuminata in the child
24. A previously healthy 52-year-old woman comes to the physician because she has had a large pimple on her right hand for 2 weeks that has failed to heal. She resides in southeastern USA where she owns a nursery and garden shop. Examination shows a painless red papule on the hand with several nontender subcutaneous nodular lesions above it. Which of the following is the most likely diagnosis?
C ) Coccidioidomycosis
D ) Histoplasmosis
E ) Sporotrichosis
33. Four hours after undergoing a cesarean delivery at term followed by tubal ligation, a 37-year-old woman, gravida 2, para 2, has dizziness and confusion. The operation was uncomplicated, and blood loss is estimated to be 800 mL. Patient-controlled epidural analgesia has been moderately effective for pain. Her blood pressure now is 80/40 mm Hg, decreased from 120/72 mm Hg intraoperatively, and pulse is 152/min, increased from 96/min intraoperatively. Breath sounds are decreased bilaterally. No murmurs are heard. Abdominal examination shows distention and tenderness. Bowel sounds are absent. The incision is intact with no drainage. She is disoriented to person, place, and time. Her hematocrit is 23%; preoperative hematocrit was 35%. Which of the following is the most likely cause of the hemodynamic changes?
A) Epidural-related hypotension
B) Insufficient intraoperative fluid replacement
C) Postoperative intra-abdominal hemorrhage
D) Supine hypotensive syndrome
E) Underestimated intraoperative blood loss
41. A 27-year-old primigravid woman at 38 weeks’ gestation is admitted in labor. Her pregnancy has been uncomplicated, and a routine prenatal visit 2 days ago showed no abnormalities. On admission, fetal heart tones cannot be heard. Ultrasonography shows little amniotic fluid, fetal edema, and no evidence of a fetal heartbeat. After 1 hour, she delivers a 3175-g (7-lb) stillborn infant; examination of the infant shows no obvious abnormalities except for mild edema. The placenta and membranes appear normal. Which of the following is the most appropriate immediate course of action?
A) Notify the hospital liability department
B) Obtain consent for fetal organ donation from the parents
C) Recommend autopsy of the infant
D) Tell the mother not to worry since she can get pregnant again
E) Tell the parents that there is a 1 in 4 chance of recurrence in future pregnancies