Академический Документы
Профессиональный Документы
Культура Документы
very concerned about these side effects because her mother fractured her hip in a
minor fall due to osteoporosis. Which of the following is the best option for prevention of
bone loss?
A. Regular exercise
B. Calcium supplementation
C. Progesterone therapy
D. Vitamin D supplementation
E. Estrogen therapy
F. Prednisone
G. Calcium and phosphate supplementation
H. Increased protein intake
17. For the past 15 years, a 72 year old female has experienced a loss in height and has
had a chronic back ache, resulting in a forward curvature of the spine. Radiographs of
the vertebral column show decreased bone density and wedge shaped flattening of the
vertebral bodies in the mid thoracic region. Which of the following is the most likely
pathogenesis of this clinical condition?
A. Decreased estrogen
B. Genetic defect in osteoclast
C. Hypovitaminosis D
D. Metastasis to bone
18. An 11-year-old boy complains of pain in his left leg with no history of prior trauma.
The
pain is not relieved by acetaminophen and slowly progresses. Radiographic
examination shows a femoral tumor with an "onion-skin" pattern of circumferential
reactive periosteal bone. Examination of biopsy material stained with hematoxylin and
eosin reveals small uniform blue round cells. On the basis of this information, which of
the following is the most likely genetic mutation?
A. del 1p
B. t(2,13)
C. t(11,22)
D. t(12,22)
E. t(X,18)
19. Radiographic studies of a 2-year-old child brought to an emergency room reveal a
new
fracture of the humerus and evidence of multiple old fractures in ribs and long bones of
the extremities. A social worker wants to initiate prosecution of the parents for child
abuse, but an alert emergency room physician notices that, despite the broken arm, the
toddler shows minimal bruising. A very careful, directed, physical examination reveals
that the toddler has "peculiar teeth," a blue tinge to the sclera, and unusually mobile
joints. The disease that the physician suspects the child has is characterized by an
abnormality of which of the following biochemical functions?
A. Collagen type I synthesis
B. Collagen type II synthesis
C. Collagen type III synthesis
D. Collagen type IV synthesis
24. A 79 year old man has had progressively worsening lower back, bilateral hip and right
shoulder pain for the past 6 years. He reports that he has had to buy larger hats. On
Physical examination there is no joint swelling, erythema, warmth or tenderness, but the
range of motion is reduced. Radiographs of the affected joint shows narrowing of joint
spaces, with adjacent bony sclerosis. A skull radiograph shows thickening of the skull
bone. . Laboratory studies show a serum alkaline phosphatase level of 173 U/L,
calcium 9.5 mg/dL and phosphorus3.4 mg /dL. A bone biopsy is performed and has the
appearance as shown below. Which of the following complications is the patient most
likely to suffer as a result of this condition?
A. Ankylosing spondylitis
B. Osteoid Osteoma
C. Osteoblastoma
D. Osteosarcoma
E. Enchondroma
25. A 30-year-old man with dwarfism is admitted to the hospital for hip replacement due
to
severe osteoarthritis. He has short arms and legs and a relatively large head. His
parents do not show signs of this congenital disease. This patient most likely has a
spontaneous mutation in the gene encoding which of the following proteins?
A. Collagen type I
B. Dystrophin
C. Fibroblast growth factor receptor
D. Growth hormone receptor
E. Insulin-like growth factor
26. A 17-year-old girl suffers a spiral fracture of her right tibia, and the leg is casted.
Unfortunately, the fracture does not heal correctly due to excessive motion and
interposition of soft tissue at the fracture site. Which of the following represents the
most likely complication of nonunion in this patient?
A. Codman triangle formation
B. Cup-shaped epiphysis
C. Involucrum formation
D. Osteomyelitis
E. Pseudoarthrosis
27. While playing in a softball game, a 35-year-old man was hit by a baseball bat on the
left
side of the head. He was unconscious for several minutes and later regained
consciousness when in transit to the hospital. He progressively lost consciousness and
died. The photograph shows the gross appearance of the brain at autopsy. Which of the
following underlying conditions best explains the cause of the lesion?
A. Cerebral atherosclerosis
B. Embolism from the heart
C. Metastatic carcinoma
D. Systemic hypertension
E. Ruptured berry aneurysm
31. A 55-year-old woman with a history of chronic rheumatic heart disease suddenly
developed weakness and sensory changes in the right side of the face and right upper
extremity. On auscultation, an opening snap and mid-diastolic rumble located at the
apex of the chest was heard. Pulse was irregular, and there was a loss of a wave in the
jugular venous pulse. On day 3 of hospitalization, the patient had cardiorespiratory
arrest and died. The photograph shows the gross appearance of the brain at autopsy.
Which of the following underlying conditions best explains the cause of the lesion?
A. Cerebral atherosclerosis
B. Embolism from the heart
C. Metastatic carcinoma
D. Systemic hypertension
E. Ruptured berry aneurysm
32. For the past 4 months, a 59-year-old man with a 30-year history of smoking cigarettes
complained of persistent headaches. For several days, he had projectile vomiting and
bilateral blurry vision. Physical examination showed bilateral papilledema. An MRI
revealed a mass lesion involving the corpus callosum with spread to both cerebral
hemispheres. The patient died a few days later of a transtentorial herniation. The
photograph shows the gross appearance of the brain at autopsy. Which of the following
underlying conditions is the most likely cause of the lesion?
A. Cerebral infarction
B. Glioblastoma multiforme (GBM)
C. Intracerebral hemorrhage
D. Medulloblastom
E. Metastaatic lung carcinoma
33. A 72-year-old man was out walking when he suddenly felt a loss of sensation and
motor
function in his right arm and in the right side of his face. He was hospitalized and died 2
weeks later. The photograph shows the gross appearance of the brain at autopsy.
Which of the following underlying conditions best explains the cause of the lesion?
A. Cerebral atherosclerosis
B. Embolism from the heart
C. Metastatic carcinoma
D. Systemic hypertension
E. Ruptured berry aneurysm
34. An 18-year-old girl comes to the emergency department because of a severe headache
and a stiff neck. Her temperature is 39.4C (103F). Physical examination shows nuchal
(neck) rigidity. A lumbar puncture is performed.
Analysis of cerebrospinal fluid shows reveals low glucose and increased protein level
with markedly increased neutrophils count. Which of the following is the most likely
diagnosis?
A. Acute purulent meningitis
B. Cryptococcal meningitis
C. Rabies encephalitis
D. Enterovirus meningitis
E. Mycobacterial meningoencephalitis
35. A 54-year-old man with polycystic kidney disease comes to the emergency
department
because of the most excruciating headache. He says that all he remembers is that he
was at work, yelling at a bratty teenager while serving food in the local high school
cafeteria, and then he woke up on the floor of the cafeteria kitchen. He says that he
must have passed out because he would never lie down on that dirty floor by choice.
Physical examination shows nuchal rigidity. A lumbar puncture is performed and shows
xanthochromasia. Which of the following is the most likely diagnosis?
and a pseudopalisade arrangement of tumor cells. The tumor is most likely one of the
following.
A. Ependymoma
B. Glioblastoma multiforme
C. Meningioma
D. Neurilemmoma (schwannoma)
E. Oligodendroglioma
40. A 70-year-old man presents with loss of memory for recent events. He has forgotten
his
grandchildrens names, and he has been unable to manage his personal finances. Also,
he has lost his way while driving to familiar locations. Which of the following is the most
likely diagnosis?
A. Alzheimer disease
B. Amyotrophic lateral sclerosis
C. Creutzfeldt-Jakob disease
D. Huntington disease
E. Parkinson disease
41. Several years ago, a 60-year-old woman had presented with bradykinesia, rigidity, a
resting pill-rolling tremor in her right hand, and mask-like, expressionless facies. She
currently presents with gait problems, taking short, shuffling steps and losing her
balance easily. Which of the following is the most likely diagnosis?
A. Alzheimer disease
B. Amyotrophic lateral sclerosis
C. Creutzfeldt-Jakob disease
D. Huntington disease
E. Parkinson disease
10. The picture shown below is of a smear of synovial fluid obtained from the right,
swollen and painful knee joint of a 65 year old man by arthrocentesis. An X- ray of the
involved knee joint reveals linear and punctuate densities in and around the articular
cartilage. The patient is a nonalcoholic. His serum uric acid is within normal range. The
pathogenesis of this disease most closely relates to
spontaneously within one week after onset. Six weeks later the patient sees his
physician because of increasingly severe lower back pain. Physical examination now
shows stiffness of the lumbar joints and tenderness affecting the sacroiliac joints. He is
treated with ibuprofen. Several months later the back pain recurs, and complains of
redness of the right eye and blurred vision. Serologic testing for which of the following is
most likely to be positive in this patient?
A. Rheumatoid factor
B. Chalmydia trachomatis
C. EBV
D. HLA-B27
E. Borrelia burgdorferi
15. An 85-year-old man presents with a 3-week history of painful swelling of his right
knee.
Aspiration of joint fluid returns numerous neutrophils and crystals, which are described
as rhomboid and coffin-like. Chemical analysis shows that these crystals are composed
of calcium pyrophosphate. Which of the following is the most likely diagnosis?
A. Ankylosing spondylitis
B. Gout
C. Infectious arthritis
D. Pseudogout
E. Rheumatoid arthritis