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9- A
10- A

12. A 52-year-old woman comes to the physician because of decreased libido; this symptom began 8 months ago, after she underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy for leiomyomata uteri and menorrhagia. She has been taking hormone replacement therapy with conjugated estrogen since the operation. Examination shows a moist, rugated vagina. Which of the following is the most likely cause of these findings?

A) Decreased androgens

B) Decreased estrogen

C) Decreased follicle-stimulating hormone (FSH)

D) Decreased luteinizing hormone (LH)

E) Decreased progesterone

F) Decreased prolactin

G) Increased androgens

H) Increased estrogen

I) Increased FSH

J) Increased LH

K) Increased progesterone

L) Increased prolactin

Actually 9 might be B-Pompe's: hypotonia, cardiomegaly...

16. A 1-year study of a new drug to treat hypertension is conducted. One hundred patients with hypertension are enrolled; 50 patients are given the new drug and another 50 patients are given hydrochlorothiazide. All patients completed the trial. One noted unexpected effect is increased growth of scalp hair which occurred in those taking the new drug, a nonstatistically significant difference (p>0.10). This effect has also been reported in studies of other similar drugs in the new therapeutic class. The investigators of the study concluded that the new drug did not cause hair growth. Which of the following features of this study is most likely to affect the validity of this conclusion?

A) Differential follow-up

B) Lead time bias

C) Length of the study

D) Sample size

E) Self-selection

19. A 6-year-old boy is brought to the physician by his mother because of progressive visual loss over the past year. Over the past 2 years, he has had deterioration of his hearing, speech, writing, and intellectual performance. His maternal uncle had similar symptoms. Visual acuity is 20/200 bilaterally. Funduscopic examination shows optic atrophy. His hearing is markedly impaired. There is weakness and spasticity of all extremities. Deep tendon reflexes are extremely hyperactive. Babinski's sign is present bilaterally. On mental status examination, he is not oriented to place, year, month, or the names of his siblings. An MRI of the brain shows marked symmetric white matter disease involving all lobes. Diagnostic studies are most likely to show which of the following? C

A) Abnormally decreased serum cholesterol level

B) Acanthocytes on blood smear

C) An excess of very long chain fatty acids

D) Normal nerve conduction studies

E) Vitamin E deficiency

What is the diagnosis?

22. A 5-year-old boy is brought to the emergency department 30 minutes after he fainted at home after standing up from a sitting position. His symptoms began 3 days ago with diarrhea and vomiting. He has had no urine output for 18 hours. He is alert but quiet. His temperature is 37.5 C (99.5 F), blood pressure is 75/45 mm Hg, pulse is 120/min, and respirations are 28/min. Examination shows dry lips and tenting of the skin. There is no abdominal tenderness. Bowel sounds are hyperactive. The remainder of the examination shows no abnormalities. His capillary refill time is 5 seconds. Intravenous bolus doses of 0.9% saline are administered. Bladder catheterization yields 5 mL of urine. Urinalysis is most likely to show which of the following? C

A) Blood

B) Erythrocyte casts

C) Hyaline casts

D) Leukocyte casts

E) Oxalate crystals

2-E
3-D
4-D
5-D

16-AA
19-CC......METACHROMIC LEUOKODYSTROPHY
22-CC

38. A 70-year-old man comes to the physician because of urinary hesitancy and frequency for 9 months. His temperature is 37.5 C (99.5 F). Examination shows a circumcised penis with no urethral discharge. Testicular examination shows no abnormalities. Rectal examination shows an enlarged rubbery prostate that is nontender to palpation. Urinalysis shows many leukocytes and no erythrocytes. Gram's stain of urine shows gram-negative rods. Which of the following is the most likely cause of this patient's condition?

A) Infection of the epididymis

B) Infection of the prostate

C) Infection of the urethra

D) Neurogenic bladder

E) Outflow obstruction of the bladder

E - BPH?