03-11-2006, 08:11 PM
26. A 69-year-old man has been taking a dopamine agonist for 4 weeks for Parkinson disease. He has had some benefit from this treatment and decides on his own to increase his dosage. Which of the following adverse effects is most likely to result from this increase in dosage?
A. Depression
B. Exaggerated tremor
C. Generalized hypotonia
D. Psychosis
E. Tardive dyskinesia
27. A 4-year-old child develops a fever, sore throat, ulcerated lesions on the oral mucosa, and a rash on the hands and feet. Which of the following is the most likely viral cause?
A. Adenovirus type 12
B. Coxsackievirus
C. Cytomegalovirus
D. Influenza virus
E. Marburg virus
F. Mumps virus
G. Parvovirus B19
H. Poliovirus type 1
I. Rhinovirus type 8
28. Which of the following labeled structures in the electron micrograph is present in cardiac muscle but not in skeletal muscle?
A. A
B. B
C. C
D. D
29. A 73-year-old man is brought to the emergency department because of excruciating low back pain that began while he was painting his garage 1 day ago. He visits the physician every 6 months for monitoring of hypertension well controlled with a diuretic. An x-ray of the spine shows several osteoblastic lesions in the vertebrae. Which of the following is the most likely diagnosis?
A. Malignant lymphoma
B. Metastatic lung carcinoma
C. Metastatic prostate carcinoma
D. Multiple myeloma
E. Osteosarcoma
30. A 9-year-old girl with cystic fibrosis is brought to the emergency department because of a 12-hour history of fever, severe shortness of breath, and cough productive of thick sputum. Her temperature is 39°C (102.2°F), pulse is 80/min, respirations are 30/min, and blood pressure is 90/60 mm Hg. Diffuse wheezing and scattered rhonchi are heard on auscultation of the chest. The CT scan of the chest shown depicts multiple dilated structures which are a result of multiple infections (as indicated by the arrows). The dilated structures are most likely which of the following?
A. Bronchi
B. Interlobular septae
C. Pulmonary arteries
D. Pulmonary veins
E. Subpleural septae
31. A 25-year-old man comes to the emergency department because of a productive cough, fever, night sweats, shortness of breath, malaise, weight loss, and poor appetite that have progressively worsened over the past 3 weeks. He has worked in construction in the USA since emigrating from Thailand 1 year ago. His temperature is 38.3°C (101°F) and respirations are 30/min. He appears emaciated and has prominent needle tracks on his forearms. Which of the following is the most likely diagnosis?
A. Acute respiratory distress syndrome
B. Atypical viral pneumonia
C. Disseminated tuberculosis
D. Hypersensitivity pneumonitis
E. Metastatic carcinoma of the lung
F. Mycoplasmal pneumonia
32. An 80-year-old woman dies shortly after admission to the hospital because of a 3-day history of progressively increasing shortness of breath. She had a history of heart failure. Examination of the lungs during autopsy shows alveolar damage with distended lymphatics, congested alveolar capillaries, and pink-staining homogenous proteinaceous hyaline material in alveoli. Which of the following is the most likely cause of these findings?
A. Amyloidosis
B. Aspiration pneumonitis
C. Emphysema
D. Pneumonia
E. Pulmonary edema
F. Septic shock
33. An 83-year-old woman comes to the physician for an annual examination. The physician hears a new murmur that is indicative of aortic stenosis. Which of the following diagrams best depicts the murmur?
A. A
B. B
C. C
D. D
E. E
34. A 14-year-old girl is admitted to the hospital because of palpitations, an irregular pulse, migratory polyarthritis, and a low-grade fever. She had acute tonsillitis 3 weeks ago. Assays for antistreptococcal antibodies and C-reactive proteins are positive. Her 10-day stay in the hospital is uneventful, and her ECG changes have resolved. Prophylactic antistreptococcal therapy is used for prevention of which of the following long-term sequelae?
A. Aschoff bodies
B. Fibrinous pericarditis
C. Mitral valve stenosis
D. Polyarthritis
E. Sydenham chorea
35. Coronary blood flow is studied in an animal model of ischemic heart disease. In this model, coronary blood flow is normal when the animal is at rest, but when the animal becomes active coronary vasoconstriction occurs and coronary blood flow decreases. The most likely cause of the observed vasoconstriction is the action of which of the following on vascular smooth muscle?
A. Adenosine
B. Nitric oxide
C. Norepinephrine
D. Oxygen
E. Prostacyclin
A. Depression
B. Exaggerated tremor
C. Generalized hypotonia
D. Psychosis
E. Tardive dyskinesia
27. A 4-year-old child develops a fever, sore throat, ulcerated lesions on the oral mucosa, and a rash on the hands and feet. Which of the following is the most likely viral cause?
A. Adenovirus type 12
B. Coxsackievirus
C. Cytomegalovirus
D. Influenza virus
E. Marburg virus
F. Mumps virus
G. Parvovirus B19
H. Poliovirus type 1
I. Rhinovirus type 8
28. Which of the following labeled structures in the electron micrograph is present in cardiac muscle but not in skeletal muscle?
A. A
B. B
C. C
D. D
29. A 73-year-old man is brought to the emergency department because of excruciating low back pain that began while he was painting his garage 1 day ago. He visits the physician every 6 months for monitoring of hypertension well controlled with a diuretic. An x-ray of the spine shows several osteoblastic lesions in the vertebrae. Which of the following is the most likely diagnosis?
A. Malignant lymphoma
B. Metastatic lung carcinoma
C. Metastatic prostate carcinoma
D. Multiple myeloma
E. Osteosarcoma
30. A 9-year-old girl with cystic fibrosis is brought to the emergency department because of a 12-hour history of fever, severe shortness of breath, and cough productive of thick sputum. Her temperature is 39°C (102.2°F), pulse is 80/min, respirations are 30/min, and blood pressure is 90/60 mm Hg. Diffuse wheezing and scattered rhonchi are heard on auscultation of the chest. The CT scan of the chest shown depicts multiple dilated structures which are a result of multiple infections (as indicated by the arrows). The dilated structures are most likely which of the following?
A. Bronchi
B. Interlobular septae
C. Pulmonary arteries
D. Pulmonary veins
E. Subpleural septae
31. A 25-year-old man comes to the emergency department because of a productive cough, fever, night sweats, shortness of breath, malaise, weight loss, and poor appetite that have progressively worsened over the past 3 weeks. He has worked in construction in the USA since emigrating from Thailand 1 year ago. His temperature is 38.3°C (101°F) and respirations are 30/min. He appears emaciated and has prominent needle tracks on his forearms. Which of the following is the most likely diagnosis?
A. Acute respiratory distress syndrome
B. Atypical viral pneumonia
C. Disseminated tuberculosis
D. Hypersensitivity pneumonitis
E. Metastatic carcinoma of the lung
F. Mycoplasmal pneumonia
32. An 80-year-old woman dies shortly after admission to the hospital because of a 3-day history of progressively increasing shortness of breath. She had a history of heart failure. Examination of the lungs during autopsy shows alveolar damage with distended lymphatics, congested alveolar capillaries, and pink-staining homogenous proteinaceous hyaline material in alveoli. Which of the following is the most likely cause of these findings?
A. Amyloidosis
B. Aspiration pneumonitis
C. Emphysema
D. Pneumonia
E. Pulmonary edema
F. Septic shock
33. An 83-year-old woman comes to the physician for an annual examination. The physician hears a new murmur that is indicative of aortic stenosis. Which of the following diagrams best depicts the murmur?
A. A
B. B
C. C
D. D
E. E
34. A 14-year-old girl is admitted to the hospital because of palpitations, an irregular pulse, migratory polyarthritis, and a low-grade fever. She had acute tonsillitis 3 weeks ago. Assays for antistreptococcal antibodies and C-reactive proteins are positive. Her 10-day stay in the hospital is uneventful, and her ECG changes have resolved. Prophylactic antistreptococcal therapy is used for prevention of which of the following long-term sequelae?
A. Aschoff bodies
B. Fibrinous pericarditis
C. Mitral valve stenosis
D. Polyarthritis
E. Sydenham chorea
35. Coronary blood flow is studied in an animal model of ischemic heart disease. In this model, coronary blood flow is normal when the animal is at rest, but when the animal becomes active coronary vasoconstriction occurs and coronary blood flow decreases. The most likely cause of the observed vasoconstriction is the action of which of the following on vascular smooth muscle?
A. Adenosine
B. Nitric oxide
C. Norepinephrine
D. Oxygen
E. Prostacyclin