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34. A previously healthy 67-year-old man is admitted to the hospital because of lethargy, confusion, muscle cramps, and decreased appetite for 7 days. He appears ill. His temperature is 37 C (98.6 F), blood pressure is 120/70 mm Hg, pulse is 98/min, and respirations are 20/min. Breath sounds are diminished at the right lung base. Neurologic examination shows no abnormalities except for lethargy. Serum studies show:

Na+
114 mEq/L
K+
4.3 mEq/L
Creatinine
1 mg/dL
Thyroid-stimulating hormone
4.1 μU/mL

An x-ray film of the chest shows a 2-cm nodule in the right lower lobe and mediastinal adenopathy. A biopsy specimen of the nodule is most likely to show which of the following?

A
) Adenocarcinoma

B
) Clear cell carcinoma

C
) Mesothelioma

D
) Small cell carcinoma

E
) Squamous cell carcinoma

35. A 62-year-old woman comes to the physician because of bloating and cramping abdominal pain and intermittent diarrhea over the past 5 years. Her symptoms have increased over the past month since she started a new diet that emphasizes yogurt and cottage cheese as low-fat sources of calcium and protein. Vital signs are within normal limits. Abdominal examination shows diffuse tenderness to palpation with no rebound tenderness; there are no masses or organomegaly. Bowel sounds are increased. Test of the stool for occult blood is negative. Which of the following is the best explanation for this patient's diarrhea?

A
) Impaired intestinal motility

B
) Inflammatory process

C
) Malabsorption

D
) Secretory process

34. D, ADH secreting

35. D

34...IT IS PERIPHRAL TUMOR....+NO H/O SMOKING... MAY BE ... AA
35...DIFFUSE TENDERNESS WITH OUT REBOUND TENDERNESS...BB

32...DD......ANALGESIC NEPHROPATHY
33...BB

31-D
30-CHRONIC ALCOHOLIC..........GOUT DUE TO COMPET. ANTAGONIST WITH URIC ACID AT TUBULAR SEC. SITES
PERIPH. NEUROPATHY DUE TO ALCOHOL
FORGETFUL+(CHRONIC ABD. PAIN DUE TO LIVER)+HEADACHE.+
ATAXIA DUE TO WERNICKS ENCEPHALOPATHY IS THE DIAGNOSIS
SO ANSWER IS ...DD...... DETECT DEGENERATIVE CHANGES............IF CHOICE DD NOT PRESENT ANSWER WOULD BE CC TO EXCLUD ALCOHOLIC LIVER CIRRHOSIS
......MY BEST REGARDS.....RAHEEM CONARD FISHER

34. how do u explain hyponatrimea with adeno

35. isnt it lactose intolerance?

36. A 52-year-old woman comes to the physician because of a 3-month history of intermittent bloody discharge from the right breast. She does not perform regular monthly breast self-examinations. She has a 3-year history of major depressive disorder treated with fluoxetine. Examination of the breasts shows no abnormalities. No masses are noted on palpation. Serosanguineous fluid can be expressed from the nipple of the right breast by pressing on the left side of the areola. Which of the following is the most likely diagnosis?

A
) Cystosarcoma phyllodes

B
) Fat necrosis

C
) Fibroadenoma

D
) Fibrocystic changes of the breast

E
) Galactorrhea

F
) Hyperprolactinemia

G
) Intraductal papilloma

H
) Mastitis

I
) Paget's disease of the breast

37. 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

36.G

37.F

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

39. A 32-year-old woman comes to the physician because of lethargy and boredom since the birth of her son 5 months ago. She worries about her ability to care for him and has had frequent palpitations. She is unable to fall back asleep after nighttime feedings. She stopped breast-feeding 1 month ago. Her son is healthy, and growth and development are normal for his age. Her blood pressure is 122/80 mm Hg, pulse is 58/min, and respirations are 18/min. Physical examination shows no abnormalities. She remembers one out of three objects after 5 minutes. Her serum cholesterol level is 265 mg/dL. The most appropriate next step in diagnosis is measurement of which of the following serum levels?

A
) Cortisol

B
) Estrogen

C
) Progesterone

D
) Prolactin

E
) Thyroid-stimulating hormone

38.E

39.E