1. A 75-year-old man with a 5-year history of stable angina pectoris is brought to the emergency department with severe chest pain. EKG reveals profound ST segment elevations, and die CK-MB level is elevated. On stabilization, the patient is admitted to the coronary care unit for further management. Several days later, the patient again complains of chest pain. Physical examination is significant for fever, loud pericardial friction rub, mild pulmonary rales, and 1+ pitting edema of the lower extremities. Which of the following is the most likely diagnosis?
(A) Caseous pericarditis
(B) Fibrinous pericarditis
(C) Hemorrhagic pericarditis
(D) Serous pericarditis
(E) Suppurative pericarditis
2. A 46-year-old woman presents to her physician complaining of weakness and fatigue. On physical examination, her physician notices a 10-lb weight gain since her last visit 6 months ago. Her blood pressure is 160/100 mm Hg. Blood tests reveal serum Na+ 155 mEq/L, K+ 2.8 mEq/L, and decreased serum renin. Which of the following is the most likely diagnosis?
(A) Cushing syndrome
(D) Primary aldosteronism
(E) Secondary aldosteronism
3. Abnormal immune reactions play a crucial role in the pathogenesis of many dermatologic conditions. Which of the following disorders is mediated by a type IV hypersensitivity reaction?
(A) Acne vulgaris
(B) Bullous pemphigoid
(E) Discoid lupus erythematosus
(G) Pemphigus vulgaris
4. A 41-year-old obese woman with a history of biliary colic presents with right upper quadrant discomfort and pain in her right shoulder after eating a fatty meal. Physical examination is significant for marked right upper quadrant tenderness during inspiration. Which of the following structures is most likely involved in producing her shoulder pain?
(A) Expiratory motor neuron
(B) Inspiratory motor neuron
(C) Intercostal nerve
(D) Phrenic nerve
(E) Vagus nerve
5. On a routine physical examination for medical insurance, a midsystolic ejection murmur is detected in the pulmonic area of a 35-year-old female executive. The cardiac examination also reveals a prominent right ventricular cardiac impulse and wide and fixed splitting of the second heart sound. An EKG shows right axis deviation, and a chest x-ray film shows enlargement of the right ventricle and atrium. Which of the following is the most likely diagnosis?
(A) Aortic stenosis
(B) Atrial septal defect
(C) Mitral regurgitation
(D) Mitral stenosis
(E) Pulmonary valve stenosis
6. A 5-year-old boy, hospitalized for cellulitis, exhibits global denudation of the skin resulting from splitting of the epidermis at the stratum granulosum. Which of the following is the most likely diagnosis?
(C) Scalded skin syndrome
(D) Tinea corporis
7. A 6-month-old child has an eye surgically enucleated because it contains a retinoblastoma. To which of the following structures should the pathologist pay particular attention when evaluating the specimen?
(A) Anterior chamber
(D) Optic nerve
8. A 14-year-old boy is brought to the physician because his mother noticed that his face looked puffy. The boy has no complaints, other than a recent upper respiratory infection that has resolved. No significant medical history is evident except for hay fever during the spring and summer. On examination, the boy is normotensive, has significant periorbital swelling, and 1+ pitting edema of both extremities. Urine dipstick reveals 3+ proteinuria and no blood. No casts are seen on microscopic examination. 24-hour urine reveals 3.7 g/day protein. Serum albumin is 2.4 g/dL, and LDL cholesterol is 290 mg/dL. A renal biopsy would reveal which of die following on light microscopic examination?
(A) Diffuse mesangial proliferation
(B) Multiple spikes in the glomerular basement membranes
(C) Normal histologic appearance of glomeruli
(D) Segmental sclerosis and hyalinization of various glomeruli
9. Conjoined twins are born attached at the chest. Examination of the placenta would likely reveal which of the following arrangements of the fetal membranes?
(A) Diamnionic, dichorionic
(B) Diamnionic, fused dichorionic
(C) Diamnionic, monochorionic
(D) Monoamnionic, dichorionic
(E) Monoamnionic, monochorionic
10. A 36-year-old man with ulcerative colitis develops pruritus and fatigue. Alkaline phosphatase is elevated. The biliary tree appears beaded on barium radiograph. Which of the following is the most likely diagnosis?
(A) Acute cholecystitis
(C) Chronic cholelithiasis
(D) Gallstone ileus
(E) Sclerosing cholangitis
11. A 14-year-old boy presents with a 1-month history of 14. knee pain and a 6-pound weight loss. He is pale and afebrile. An x-ray film reveals a densely sclerotic lesion in the distal femur extending from the growth plate into the diaphysis. The periosteum is lifted, forming an angle with the cortex. The surrounding soft tissue resembles a "sunburst" on the radiograph. Which of the following is the most likely diagnosis?
(A) Nonossifying fibroma
(E) Paget disease
12. A gastroenterologist performs a colonoscopy on a patient 15. with a family history of gastric and colon cancer and discovers multiple polyps. Biopsy of one lesion reveals a benign hamartoma. On physical examination the patient is noted to have dark pigmentation of the buccal mucosa and lips. What is the most likely diagnosis?
(A) Adenomatous polyposis coli
(B) Gardner syndrome
(C) Peutz-Jeghers (PJ) syndrome
(D) Turcot syndrome
13. A 36-year-old gravid woman notes vaginal bleeding. Ultrasound reveals small grape-like cystic structures without evidence of a developing embryo. A diagnosis of complete hydatidiform mole is made at the hospital. Further analysis is most likely to reveal that
(A) the genotype of the mole is 46, XX and is completely paternal in origin
(B) the genotype of the mole is triploid
(C) human chorionic gonadotropin (hCG) levels are markedly decreased
(D) serum levels of alpha fetoprotein are elevated
(E) two or more sperm fertilized the ovum
A 22-year-old man with fatigue, recurrent fever, and enlarged cervical lymph nodes has numerous atypical lymphocytes in his peripheral blood smear. A biopsy from the patient's enlarged node shows expansion of lymphoid follicles with preservation of the underlying architecture. Numerous atypical lymphocytes are present in the paracortical areas. Which of the following is the most likely diagnosis?
(B) Burkitt lymphoma
(C) Hodgkin disease
(E) Non-Hodgkin lymphoma
A 70-year-old man experiences continuous lower abdominal discomfort with alternating constipation and diarrhea. His symptoms seem to improve on a high-fiber diet. If exploratory surgery were performed, which of the following would the surgeon most likely see?
(A) An inflamed and fibrosed appendix
(B) Multiple diverticula of the rectosigmoid colon
(C) Normal small and large intestine
(D) Thick, rubbery small and large intestinal walls
(E) A trabeculated, dilated bladder
16. A 45-year-old man is diagnosed with primary hypoaldosteronism. Which of the following laboratory results is most consistent with this diagnosis?
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